Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum
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This paper describes the use of laparoscopically assisted vaginal management for treating deep endometriosis infiltrating the rectovaginal septum.
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Abstract
BackgroundTwo aims: 1) To assess the results of laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum (RVS); 2) to pinpoint the differences between this procedure and that used for deep endometriotic lesions located on the uterosacral ligaments (USL).MethodsDescriptive retrospective study. Twenty-nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series.ResultsOne patient only (3.5%) presented a major complication of the recto-vaginal fistula type. After a one step reoperation under anesthesia, the post operative history was uncomplicated and no sequelae are to be deplored. With respect to dysmenorrhea (DM), deep dyspareunia (DP) and chronic pelvic pain (CPP), there was an improvement in respectively 91.7% (22 patients), 100% (24 patients) and 92.9% (13 patients) of cases. For each of these 3 symptoms the median score according to the visual analog scale was significantly lower after the operation (for DM: 7.6+/-2.0 versus 1.7+/-2.6; for DP 7.5+/-1.9 versus 0.5+/-1.1; for CPP 5.9+/-2.8 versus 1.4+/-3.2) (p<0.0001).ConclusionsThese results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic infiltrating the RVS. From the technical point of view the rectum must be freed, leaving the deep endometriotic nodule attached to the posterior wall of the vagina. Resection of the whole lesion requires the posterior wall of the vagina to be resected, whereas ureterolysis is often unnecessary. So for lesions located on the RVS the vagina is opened systematically, unlike the situation when resecting deep endometriotic lesions infiltrating the USL. Deep pelvic endometriosis is not synonymous with endometriosis of the RVS. Lesions truly infiltrating the RVS represent only a small proportion of all deep endometriosis lesions.
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Cited by (34)
- Endometriosis del tabique rectovaginal 2023
- Role of Laparoscopy in Endometriosis 2022
- Effect of bazedoxifene on expressions of VEGF, VEGFR2, COX-2 and inflammatory factors in a rat endometriosis model 2021
- Deep endometriosis: The place of laparoscopic shaving 2020
- Manejo Quirúrgico de la Endometriosis Colorrectal 2020
- Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection 2019
- Infertilité et endométriose : quelle prise en charge ? 2019
- Evaluation of sexual function in women with deep infiltrating endometriosis 2018
- [Impact of osteopathic manipulative therapy in patient with deep with colorectal endometriosis: A classification based on symptoms and quality of life] 2017
- Colorectal endometriosis and fertility 2016
- Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE) 2015
- [Rectovaginal endometriosis--analysis of 160 cases] 2015
- Long-term outcomes on quality of life in women submitted to laparoscopic treatment for bowel endometriosis 2014
- Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: results of a systematic three-step vagino-laparoscopic approach 2013
- Surgical strategy in endometriosis 2013
- Multidisciplinary laparoscopic treatment for bowel endometriosis 2013
- Técnica laparoscópica reversa en el manejo quirúrgico de la endometriosis profunda del tabique rectovaginal: experiencia preliminar 2012
- Laparoscopy for Diagnosis and Treatment of Endometriosis 2011
- Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain 2011
- Rectovaginal endometriosis-characteristics of operative treatment and factors predicting bowel resection 2009
- [Colorectal endometriosis and fertility] 2008
- Short-term outcome of fertility-sparing laparoscopic excision of deeply infiltrating pelvic endometriosis performed in a tertiary referral center 2008
- Outcome of laparoscopic colorectal resection for endometriosis 2007
- [Guidelines for the management of painful endometriosis] 2007
- Tratamento da endometriose 2006
- Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? 2006
- Síntomas dolorosos de la endometriosis 2006
- Symptômes douloureux de l'endométriose 2006
- Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification 2005
- Symptômes douloureux de l'endométriose 2005
- Role of the vaginally administered aromatase inhibitor anastrozole in women with rectovaginal endometriosis: a pilot study 2005
- Radical resection of invasive endometriosis with bowel or bladder involvement--long-term results 2005
- [Surgical management of rectovaginal septum endometriosis from a continuous series of 50 cases] 2004
- Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis 2002
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