Laparoscopic Discoid Rectal Endometriosis Resection: The Squeeze Technique

In: Clinical Management of Bowel Endometriosis · 2020 · pp. 113–118 · doi:10.1007/978-3-030-50446-5_10 · W3083667688
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The squeeze technique for laparoscopic discoid rectal endometriosis resection allows for maximal bowel sparing and primary closure without bowel resection in select patients.

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This paper describes a laparoscopic technique for excising full-thickness rectal endometriosis using a discoid resection intended to avoid bowel resection. It focuses on selecting patients with a single anterior rectal nodule under 3 cm that does not involve more than half the bowel circumference, and reports that gently “squeezing” the nodule and “bouncing off” helps preserve unaffected bowel while achieving disease-free surgical margins, enabling primary two-layer closure. A key limitation noted is that the approach is presented with specific anatomical criteria for candidacy rather than as a broadly applicable method. This paper is centrally about endometriosis — it presents a laparoscopic discoid excision (“squeeze technique”) for rectal endometriosis.

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Abstract

Laparoscopic excision of full thickness rectal endometriosis using a discoid resection can avoid the need for a bowel resection. This may help avoid some of the morbidity and prolonged hospitalization that can be associated with larger bowel surgery. Patients with a single anterior nodule that is less than 3 cm and do not involve more than half of the circumference of the bowel are good candidates for this surgical approach. The maximum amount of unaffected bowel can be spared, while still obtaining disease free surgical margins, by gently squeezing the nodule and bouncing off. This technique shows the surgeon where to make the proper incision and allows for a primary two-layer closure rather than a bowel resection. Link to video (https://www.youtube.com/watch?v=Ub1j7um6Tco). Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Meuleman C, Tomassetti C, D’Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311–26. Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21(3):329–39. Oliveira MAP, Crispi CP, Oliveira FM, Junior PS, Raymundo TS, Pereira TD. Double circular stapler technique for bowel resection in rectosigmoid endometriosis. J Minim Invasive Gynecol. 2014;21(1):136–41. Laganà AS, Vitale SG, Trovato MA, Palmara VI, Rapisarda AMC, Granese R, et al. Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int. 2016;2016:3617179. Kondo W, Ribeiro R, Zomer MT, Hayashi R. Laparoscopic double discoid resection with a circular stapler for bowel endometriosis. J Minim Invasive Gynecol. 2015;22(6):929–31. De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: a systematic review. BJOG. 2011;118(3):285–91. Jayot A, Nyangoh Timoh K, Bendifallah S, Ballester M, Darai E. Comparison of laparoscopic discoid resection and segmental resection for colorectal endometriosis using a propensity score matching analysis. J Minim Invasive Gynecol. 2018;25(3):440–6. Abrão MS, Podgaec S, Dias JA, Averbach M, Silva LFF, Marino de Carvalho F. Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol. 2008;15(3):280–5. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations 10.1 Electronic Supplementary Material (MOV 1658605 kb) Rights and permissions Copyright information © 2020 Springer Nature Switzerland AG About this chapter Cite this chapter Lee, T., Rindos, N. (2020). Laparoscopic Discoid Rectal Endometriosis Resection: The Squeeze Technique. In: Ferrero, S., Ceccaroni, M. (eds) Clinical Management of Bowel Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-030-50446-5_10 Download citation DOI: https://doi.org/10.1007/978-3-030-50446-5_10 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-50445-8 Online ISBN: 978-3-030-50446-5 eBook Packages: MedicineMedicine (R0)

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endometriosis

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