VP62.03: Ultrasonographic persistence of rectal endometriosis after laparoscopic shaving of rectovaginal endometriosis infiltrating the rectum

To assess the risk of rectal endometriosis persistence after laparoscopic shaving of rectovaginal nodules infiltrating the rectum. This prospective study included 68 patients who underwent shaving for rectovaginal nodules infiltrating the rectum. The criteria for inclusion in the study were: reproductive age, rectovaginal endometriosis infiltrating the rectum treated by laparoscopic shaving, the judgement of the surgeon who considered rectal endometriosis to be excised entirely. At 3- and 6-month from surgery, the presence of persistent endometriosis was assessed by rectal-water contrast transvaginal ultrasonography (RWC-TVS). At each follow-up, patient satisfaction, variations in pain, and intestinal symptoms were evaluated. The mean ( ± SD) age of the study population was 35.8 ± 4.6 years. The mean ( ± SD) largest diameter of the endometriotic nodule was 28.9 ± 14.8 mm. At a 3-month follow-up, the persistence of rectal endometriosis was observed by RWC-TVS in 3 (4.4%; 95% CI, 0.9%-12.4%) patients. The nodules were detected in the area where the rectal shaving was performed. The mean (± SD) largest diameter of the persistent rectal endometriotic nodule detected at ultrasonography was 8.8 ( ± 2.4) mm; its mean ( ± SD) volume was 180.0 ( ± 74.7) mm. Pain and intestinal symptoms were improved by surgery also in patients with persistence of endometriosis. The 6-month follow-up confirmed the persistence of rectal endometriosis in the 3 patients. This study demonstrates that ultrasonographically detectable persistence of rectal endometriosis is a rare event after laparoscopic shaving of rectovaginal nodules infiltrating the rectum. Postoperative improvement of pain and intestinal symptoms is also observed in patients with persisting rectal endometriosis. Future studies should assess the clinical relevance of the persistence of small rectal endometriotic lesions after shaving.