{"paper_id":"0535be22-d5fa-49c2-abcd-2f103a6908b9","body_text":"Abstract\nIntroduction and hypothesis\nEndometriosis is a gynecological condition characterized by endometrial tissue outside of the uterus. It affects up to 15% of women of reproductive age. In the case of bowel infiltration, about 90% of lesions are localized on the sigmoid colon or the rectum and may interfere with bowel function. Three surgical approaches are possible: (1) shaving technique, (2) discoid resection of the nodule, and (3) segmental resection with end-to-end anastomosis. A rectovaginal fistula is feared as a postoperative complication mainly in simultaneous resection of the vaginal and the rectosigmoid nodules. Its prevention is a two-step surgery (the first operation on the vagina and the second on the colon) or a preventive colostomy, both of which are often thought to be too invasive for a benign condition. Herein, we suggest a one-step surgery to prevent its development.\nMethods\nIn three women, a concomitant laparoscopic resection of the vaginal and rectosigmoid endometrial nodule was completed with interposition of a mesorectal flap.\nResults\nAll surgeries were uncomplicated with no rectovaginal fistula in the postoperative period.\nConclusion\nIn the hands of skilled surgeons, this one-step technique can be used to prevent rectovaginal fistula development.\nReferences\nZheng Y, et al. Rectovaginal fistula following surgery for deep infiltrating endometriosis: does lesion size matter? J Int Med Res. 2018;46(2):852–64.\nChampagne BJ, McGee MF. Rectovaginal fistula. Surg Clin North Am. 2010;90(1):69–82 Table of Contents.\nPalanivelu C, et al. Laparoscopic management of iatrogenic high rectovaginal fistulas (type VI). Singap Med J. 2007;48(3):e96–8.\nUlrich U, et al. Interdisciplinary S2k guidelines for the diagnosis and treatment of endometriosis: short version-AWMF registry no. 015-045, August 2013. Geburtshilfe Frauenheilkd. 2013;73(9):890–8.\nMeuleman C, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311–26.\nDubernard G, et al. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod. 2006;21(5):1243–7.\nTrencheva K, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108–13.\nDousset B, et al. Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg. 2010;251(5):887–95.\nKondo W, et al. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2011;118(3):292–8.\nMaytham GD, et al. Laparoscopic excision of rectovaginal endometriosis: report of a prospective study and review of the literature. Color Dis. 2010;12(11):1105–12.\nAcknowledgements\nThis work would not be possible without our surgical nurses and other colleagues, who took care of our patients.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflicts of interest\nNone.\nAdditional information\nConsent\nWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nPrior presentation\nThis technique was presented at the 2018 European Endometriosis Conference in Vienna, Austria.\nElectronic supplementary material\n(MP4 67148 kb)\nRights and permissions\nAbout this article\nCite this article\nHanacek, J., Havluj, L., Drahonovsky, J. et al. Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis. Int Urogynecol J 30, 2195–2198 (2019). https://doi.org/10.1007/s00192-019-04030-8\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00192-019-04030-8","source_license":"public-domain-us","license_restricted":false}