Laparoscopic bowel resection of deep infiltrating endometriosis. Comparative outcomes of a public teaching hospital and a referral private hospital

Abstract Purpose To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. Methods The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. Results One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p<0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p<0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p<0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). Conclusion Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.

摘要
目的：对比公立教学医院与私立转诊医院开展腹腔镜手术治疗肠道子宫内膜异位症（bowel endometriosis）的手术结局。
方法：本研究评估的指标包括手术适应证、手术类型与时长、住院时长、临时肠造口（temporary stoma）需求、中转开腹（conversion to open surgery）率以及术后并发症发生情况。
结果：本研究共纳入181例患者，其中私立医院收治150例，占比82.9%。私立医院组中以不孕症作为手术适应证的患者占比更高（56% vs. 29%；P=0.01），且节段性肠切除术的应用更为普遍（48% vs. 29%，P=0.05）。公立教学医院组的平均手术时间更长（211.9±83.4分钟 vs. 128±55分钟，P<0.001），平均住院时长也更长（3.97±1.7天 vs. 1.56±0.85天，P<0.001）；而私立医院组的中转开腹率显著更低（2% vs. 32.3%，P<0.001）。公立教学医院组的术后并发症（Clavien-Dindo Ⅱ级及以上）发生率更高（38.7% vs. 11.3%，P=0.021；优势比[OR]=3.2，95%置信区间[CI]：1.2~8.0）。
结论：相较于公立教学医院，私立转诊中心开展的腹腔镜肠道子宫内膜异位症手术可降低严重并发症发生率、缩短手术时长与住院时长，并降低中转开腹率。