Laparoscopic colorectal resection for deep infiltrating endometriosis: can we reliably predict anastomotic leakage and major postoperative complications in the early postoperative period?



Anastomotic leakage (AL) and major complications after colorectal resection for deep infiltrating endometriosis (DIE) have a remarkable impact on patient outcomes. The aim of this study is to assess the predictive value of C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBCs) and the Dutch Leakage Score (DLS) as reliable markers in the early diagnosis of AL and major complications after laparoscopic colorectal resection for DIE.


262 consecutive women undergoing laparoscopic colorectal resection for DIE between September 2017 and September 2018 were prospectively enrolled. WBCs, CRP, PCT and DLS were recorded at baseline and on postoperative day (POD) 2, 3 and 6 then statistically analyzed as predictors of AL and severe postoperative complications.


The AL rate was 3.2%. The major morbidity rate was 11.2%. No postoperative mortality was recorded. The postoperative trend of DLS and serum levels of CRP and PCT, but not WBCs, were significantly higher in women developing AL and severe complications. DLS had better sensitivity and specificity than biomarkers on all postoperative days as a predictor of AL and major complications. CRP and PCT have a low positive predictive value (PPV) and a high negative predictive value (NPV) for AL and major complications on POD3 and POD6. The risk of malnutrition was significantly related to AL.


The combination of DLS as a standardized postoperative clinical monitoring system and CRP and PCT as serum biomarkers, allows the exclusion of AL and major complications in the early postoperative period after laparoscopic colorectal resection for DIE, thus ensuring a safe patient discharge.

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The authors thank Nicoletta De Santis, data manager, Unità per la Ricerca Clinica, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 5, 37024, Negrar di Valpolicella, Verona, Italy. The authors thank Elinor Julie Rae Anderson, medical writer freelance, for her linguistic revision of the manuscript.


This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Correspondence to Elisa Bertocchi.

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Elisa Bertocchi, Giuliano Barugola, Marcello Ceccaroni, Massimo Guerriero, Roberto Rossini, Irene Gentile and Giacomo Ruffo declare that they have no conflict of interest and nothing to disclose.

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Bertocchi, E., Barugola, G., Ceccaroni, M. et al. Laparoscopic colorectal resection for deep infiltrating endometriosis: can we reliably predict anastomotic leakage and major postoperative complications in the early postoperative period?. Surg Endosc (2021).

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  • Colorectal surgery
  • Endometriosis
  • C-reactive protein
  • Procalcitonin
  • Dutch leakage score
  • Anastomotic leak