Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum

Chapron C, Charles Chapron, C. Chapron, Jacob S, S Jacob, Sandrine Jacob, J B Dubuisson, Jean‐Bernard Dubuisson, Dubuisson JB, Vieira M, Marco Vieira, M Vieira, Liaras E, E Liaras, Etienne Liaras, Arnaud Fauconnier, A Fauconnier, Fauconnier A
Acta obstetricia et gynecologica Scandinavica · 2001 · vol. 80(4) , pp. 349–354 · doi:10.1034/j.1600-0412.2001.080004349.x · PMID:11264611 · W2097738142
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Laparoscopically assisted vaginal management of deep rectovaginal septum endometriosis significantly improved pain symptoms with a low major complication rate, involving systematic vaginal wall resection.

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Abstract

BACKGROUND: Two 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). METHODS: Descriptive retrospective study. Twenty-nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series. RESULTS: One 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). CONCLUSIONS: These 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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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Endometriosis Laparoscopy Laparoscopy Rectal Diseases Vaginal Diseases Adult Adult Endometriosis Endometriosis Female Female Humans Humans Middle Aged Middle Aged Rectal Diseases Rectal Diseases Rectovaginal Fistula Rectovaginal Fistula Rectovaginal Fistula

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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