Comparison of Laparoscopic Anterior Discoid Resection and Laparoscopic Low Anterior Resection of Deep Infiltrating Rectosigmoid Endometriosis

Nash S Moawad, Richard Guido, Richard S. Guido, Ramesh Ramanathan, Suketu Mansuria, Ted Lee
JSLS : Journal of the Society of Laparoendoscopic Surgeons · 2011 · vol. 15(3) , pp. 331–338 · doi:10.4293/108680811x13125733356431 · PMID:21985719 · W2029065477
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Laparoscopic anterior discoid resection for rectosigmoid endometriosis resulted in less operative time, blood loss, and hospital stay compared to low anterior resection, with comparable long-term outcomes and patient satisfaction.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This retrospective cohort compared laparoscopic anterior discoid resection (ADR) versus laparoscopic low anterior resection (LAR) for symptomatic rectosigmoid deep infiltrating endometriosis, using chart review and long-term telephone questionnaires to assess operative details, complications, bowel and sexual function outcomes, and satisfaction (15/22 completed long-term surveys). ADR was associated with significantly shorter operative time, less estimated blood loss, shorter hospital stay, and a lower rate of anastomotic strictures, while LAR patients had higher rates of mucosal involvement and more frequent multifocal disease; SF-12 quality-of-life scores and overall satisfaction were broadly comparable between groups. A key limitation is selection bias because procedure choice depended on surgeon discretion, the sample size was small, and long-term outcome analysis excluded those who did not complete questionnaires. This paper is centrally about endometriosis — it directly compares ADR and LAR surgical approaches for deep infiltrating rectosigmoid endometriosis and reports differences in perioperative and long-term outcomes.

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Abstract

OBJECTIVE: To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR). METHODS: This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital. Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared. RESULTS: Twenty-two patients underwent laparoscopic ADR (n 8) or LAR (n 14) for rectosigmoid endometriosis between January 2001 and December 2009. Mean follow-up time was 41.26 months (range, 14 to 70). Patients undergoing laparoscopic ADR had significantly less blood loss and shorter operative time and hospital stay. Patients who required LAR had a significantly higher rate of mucosal involvement (61.5% v. 0%). No statistically significant difference was found in the size, depth of invasion, location of lesions, or operative complications. Fifty percent of the LAR group had several lesions as opposed to 12.5% of the ADR group. Median age was significantly higher in patients who required LAR (39) than in patients who required ADR (32). Three patients in the LAR group (21.4%) had anastomotic strictures; 2 required dilation. The ADR group had consistently higher increments of improvement in bowel symptoms and dyspareunia. Overall satisfaction rate with the procedures was 93.3%. SF-12 scores were comparable between the 2 groups. CONCLUSION: ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.

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Condition tags

endometriosisdyspareunia

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Rectal Diseases Sigmoid Diseases Adult Blood Loss, Surgical Endometriosis Female Gynecologic Surgical Procedures Humans Laparoscopy Length of Stay Quality of Life Rectal Diseases Retrospective Studies Sigmoid Diseases Treatment Outcome

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