Laparoscopic resection of intestinal endometriosis: A 5-year experience

Paulo Augusto Ayroza Ribeiro, Paulo Ayroza Ribeiro, Francisco C Rodrigues, Francisco Rodrigues, Rodrigues FC, Ivani P A Kehdi, Kehdi IP, Rossini L, Lucio Rossini, Abdalla HS, Helizabet S Abdalla, Nilson Donadio, Donadio N, Aoki T, Tsutomu Aoki
Journal of Minimally Invasive Gynecology · 2006 · vol. 13(5) , pp. 442–446 · doi:10.1016/j.jmig.2006.05.010 · PMID:16962529 · W2150051000
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This paper reports on a 5-year experience with laparoscopic intestinal endometriosis resection, detailing surgical techniques and outcomes.

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Abstract

Study objectiveTo describe the clinical manifestations, surgical techniques, and complications observed in patients undergoing laparoscopic resection of intestinal deeply infiltrating endometriosis (DIE).DesignProspective nonrandomized (Canadian Task Force Classification II-3).SettingUniversity hospital and private practice.PatientsWe evaluated 125 patients with intestinal DIE treated from February 2000 through September 2005.InterventionsLaparoscopic radical excision of DIE followed by resection of the rectosigmoid colon.Measurements and main resultsThe clinical examination of our patients demonstrated that 66.4% of patients had tenderness, whereas 80.8% had nodules on the pouch of Douglas. In 95.2% we observed pain caused by cervical mobilization, and all the patients had pain during the pouch of Douglas mobilization. Regarding bowel infiltration, preoperative investigation with rectal endoscopic ultrasonography was positive in all cases. Endoscopic rectal ultrasonography demonstrated the depth of intestinal infiltration. Superficial lesions were observed in 9.6% of patients and muscularis involvement in 71.2%. The segmental resection was performed in most of the patients (92%) and the linear resection in 6.4% of them. Median surgical time was 110 minutes, and the median hospital stay was 7 days after the surgery; the patients continued fasting for 3 to 7 days. The return to normal activity was achieved in a median 15 days after the surgery. The surgical procedure and the postoperative follow-up demonstrated no complications in 90.4% of the patients. Minor complications were observed in 4% of the cases. Major complications occurred in 5.6% of the patients, including 2 cases of intestinal fistulas (1.6%) and 3 cases of long-lasting urinary retention (2.4%).ConclusionClinical symptoms of patients with intestinal endometriosis are not specific. Operative laparoscopy is a safe and effective method to treat intestinal endometriosis. To avoid major complications, special attention must be paid to the intestinal anastomosis and to the nerve preservation.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Diseases Laparoscopy Adult Colectomy Colectomy Colectomy Colon, Sigmoid Endometriosis Endometriosis Female Follow-Up Studies Humans Intestinal Diseases Intestinal Diseases Laparoscopy Laparoscopy Retrospective Studies Severity of Illness Index Treatment Outcome

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