DİE Cerrahisinde Rektosigmoid Kolonun Serviksten Diseksiyonu İçin Güvenli Cerrahi Teknik
Synopsis
Derin İnfiltratif Endometriozis (DİE), endometriozisi olan kadınların %20'sinden fazlasını etkiler. Bunun %70-93 arasında değişen, önemli bir alt kümesi rektosigmoid kolon tutulumu sergiler. DİE, infiltrasyon ve inflamasyon nedeniyle çevre organların morfolojisini, anatomisini ve pelvik avasküler alanları bozar, dokuların planları kaybolur. Dolayısıyla çoğu vakada DİE normal anatomik yapılanmayı bozduğu için cerrahi sırasında anatomik rekonstrüksiyon gerekmektedir. Cerrahisini mümkün olan en az morbiditeyle gerçekleştirebilmek için yapıların embriyolojik gelişiminin ve anatomisinin detaylı bir şekilde bilinmesi çok faydalı olacaktır. Hastaların multidisipliner yaklaşımla değerlendirilmesi gerekir. DİE cerrahisinde intraoperatif komplikasyon oranı %2, postoperatif komplikasyon oranı ise %14’e kadar artabildiğinden ameliyatın tecrübeli ekiplerce yapılması önemlidir. Ayrıca hastalara preoperatif dönemde; cerrahi seçenekleri, muhtemel komplikasyon oranları ve rekürrens riskleri hakkında mutlaka bilgilendirme yapılmalıdır. Diseksiyon yapılırken cerrah kendini güvende hissettiği ve tecrübesinin en fazla olduğu yöntemi tercih etmelidir.
Deep Infiltrative Endometriosis (DIE) affects more than 20% of women with endometriosis. Of this, a significant subset, ranging from 70-93%, exhibits involvement of the rectosigmoid colon. Due to the infiltration and inflammation, DIE disrupts the morphology and anatomy of the surrounding organs and pelvic avascular spaces, and tissue planes are lost. Therefore, in most cases, anatomical reconstruction is required at the time of surgery, as DIE disrupts the normal anatomical configuration. In order to perform surgery with minimal morbidity, a detailed knowledge of the embryologic development and anatomy of the structures will be very useful. Patients should be evaluated with a multidisciplinary approach. Since the intraoperative and postoperative complication rate in DIE surgery is 2% and 14%, respectively, it is important that the surgery is performed by experienced teams. In addition, patients should be informed about surgical options, possible complication rates and recurrence risks in the preoperative period. When performing dissection, the surgeon should prefer the method in which he/she feels safe and has the most experience.
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