Endoscopic treatment of deep infiltrating endometriosis (DIE) involving the bladder and rectosigmoid colon

BACKGROUND: To study the feasibility, complications and symptom relief of laparoscopic treatment in patients with deep infiltrating endometriosis. METHODS: From January 2004 to March 2005, 24 patients with deep infiltrating endometriosis were treated with laparoscopic techniques. Preoperative symptoms, staging, involvement of the disease, and surgical procedures were recorded. Operating time and perioperative complications were also registered, as well as follow-up of the patients. RESULTS: The surgical treatment was individualized with removal of deep infiltrating endometriosis in all 24 patients, additional bladder resection in five patients and colorectal resection in eight patients. In two cases laparoconversion was performed, and one patient had a temporary loop ileostomy. We observed no major peri- or postoperative complications. Median operating time was 3.4 h (range 1.4-8.0 h). All patients with bladder involvement were relieved of their urinary dysfunction, while all except three patients were successfully treated for their pain problems, and also these three patients had symptom relief. CONCLUSIONS: Patients with deep infiltrating endometriosis represent a challenge to surgical procedures. Our results show that radical laparoscopic surgery including colorectal and bladder resection is feasible, safe, and effective in almost all patients.