Laparoscopic Removal of Endometriosis in the Pouch of Douglas
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Abstract
EDITORIAL COMMENT": This paper provides important data on dealing, via the laparoscope, with endometriosis involving the uterosacral ligaments and peritoneum of the pouch of Douglas in patients with pelvic pain and/or infertility. None of the 26 women in this study had had a hysterectomy, although this procedure usually relieves pain associated with endometriosis involving the pouch of Douglas and uterosacral ligaments. Perhaps we require more data regarding symptoms from residual endometriosis in patients having hysterectomy and uterosacral endometriosis; relevant considerations include whether bilateral oophorectomy is also performed or whether the patient receives postoperative hormone replacement therapy in this circumstance. It seems to the editor that the uterosacral ligaments and pouch of Douglas are seldom removed when hysterectomy is performed in the type of cases reported in this paper; one achieves mobility of the uterus before its removal by cutting the uterosacral ligaments, not removing them; in these cases we are concerned about the keeping away from the ureters and rectum rather than excising scarring due to endometriosis ‐ yet the authors note that ‘biopsy of scarred lesions often shows active endometriosis! Summary: Twenty‐six patients with endometriosis in the pouch of Douglas were treated by laparoscopic excisional surgery; previous medical and surgical therapy had failed in 24 of them. Endometriosis in the pouch of Douglas occurred infrequently in association with bladder or ovarian endometriosis. Coital and rectal pain were markedly reduced or cured 6 months after surgery in all except 2 patients. Laparoscopic surgical excision of endometriosis is indicated when drug or other surgical treatments fail and may avoid the need for hysterectomy in some patients.
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References (4)
- Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease via openalex
- W1984505924 via openalex
- W2291960606 via openalex
- W2399797405 via openalex
Cited by (13)
- RECTAL ENDOMETRIOSIS: RESULTS OF RADICAL EXCISION AND REVIEW OF PUBLISHED WORK 2007
- Avaliação dos resultados do tratamento cirúrgico de pacientes portadoras de endometriose do septo retovaginal 2005
- Surgical Management of Deeply Infiltrating Endometriosis: An Update 2004
- Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification 2003
- L’endométriose pelvienne profonde : prise en charge thérapeutique et proposition d’une « classification chirurgicale » 2003
- Management of Deep Endometriosis 2001
- Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum 2001
- Laparoscopic Surgery for Endometriosis: A Long Term Follow‐Up 2000
- The diagnosis and management of infiltrating nodular recto-vaginal endometriosis 2000
- Laparoscopic anterior resection of the rectum and hysterectomy in a patient with extensive pelvic endometriosis 1998
- Laparoscopic Douglasectomy in the treatment of painful uterine retroversion 1997
- Excision of endometriosis in the pouch of Douglas by combined laparovaginal surgery using the Maher abdominal elevator 1995
- Replacement of Abdominal Hysterectomy by the Laparovaginal Technique – Its Success and Limitations 1994
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