Laparoscopic Disk Resection for Bowel Endometriosis Using a Circular Stapler and a New Endoscopic Method to Control Postoperative Bleeding from the Stapler Line

Landi S, Stefano Landi, Pontrelli G, Giovanni Pontrelli, Daniela Surico, Giacomo Ruffo, Ruffo G, Benini M, Marco Benini, M.C. Benini, Soriano D, David Soriano, Liliana Mereu, Minelli L, Luca Minelli
Journal of the American College of Surgeons · 2008 · vol. 207(2) , pp. 205–209 · doi:10.1016/j.jamcollsurg.2008.02.037 · PMID:18656048 · W2135880509
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This study reports that laparoscopic disk resection using a circular stapler for bowel endometriosis is feasible and can be managed endoscopically for stapler line bleeding.

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Abstract

BACKGROUND: Complete laparoscopic excision of endometriosis offers good longterm symptomatic relief, especially for those with severe or debilitating symptoms. Intestinal endometriosis affect between 3% and 36% of women with endometriosis and 50% of women with disease severe enough that intestinal surgery, with or without intestinal segmental resection, may be required. STUDY DESIGN: Between January 2003 and September 2006, we performed 35 laparoscopic complete excisions of endometriosis with full thickness disk resections of bowel endometriosis using the CEEA stapler (US Surgical) inserted transanally. RESULTS: The endometriotic nodule of the bowel was completely removed in all patients. No major or minor surgical complications occurred during the primary surgical procedure. One patient underwent a diverting temporary ileostomy because of air loss after insufflation of the rectosigmoid colon, which was closed successfully 1 month after surgery. In three of seven cases of rectal bleeding from the stapler line, for the first time, we successfully used conservative endoscopic management. CONCLUSIONS: In properly selected patients, full thickness disk excision using a circular stapler is a feasible procedure that avoids the potential morbidities of a low anastomosis. We suggest conservative management by endoscopic hemostasis before referring patients for a new operation in cases of rectal bleeding from the anastomotic site.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Hemostasis, Surgical Laparoscopy Rectal Diseases Surgical Staplers Adult Colonic Diseases Endometriosis Equipment Design Female Follow-Up Studies Hemostasis, Surgical Humans Laparoscopy Postoperative Complications Postoperative Complications Postoperative Complications Postoperative Hemorrhage Postoperative Hemorrhage

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (27)

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License: CC0 · commercial use OK