Die operative Therapie der tiefen Endometriose im Septum rectovaginale

J. Keckstein, O Kandolf, W. Masetti, M. Wustlich
In: Der Gynäkologe · 2002 · vol. 35(5) , pp. 465–474 · doi:10.1007/s00129-002-1198-0 · W1959009570
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Surgical removal of deep rectovaginal septum endometriosis significantly improves symptoms with low complications and is superior to medical treatment.

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The paper addresses operative therapy for deep endometriosis of the rectovaginal septum, describing how symptoms such as dysmenorrhea, dyspareunia/cohabitation complaints, bleeding disturbances, and defecation difficulties relate to lesion extension, involvement of neighboring organs, and endometriosis activity. It discusses that in severe symptomatic cases surgical removal is required, with surgical access chosen according to surgeon experience and lesion location, aiming for complete excision (an R0 situation) while noting possible compromises when fertility preservation or organ conservation is necessary. The authors report that radical surgery leads to marked symptom improvement and a relatively low complication rate, and they state that surgical treatment is superior to medical therapy for extensive findings. This paper is centrally about endometriosis — specifically the operative management of deep endometriosis infiltrating the rectovaginal septum.

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Zusammenfassung Die tiefe Endometriose im Septum rectovaginale gilt als besondere Form der Endometriose. Die Symptome Dysmenorrhoe, Kohabitationsbeschwerden, Blutungsstörungen sowie Defäkationsbeschwerden hängen von der Ausdehnung des Befundes bzw. von der Mitbeteiligung der Nachbarorgane ab. Daneben spielt der Aktivitätsgrad der Endometriose eine große Rolle. Bei ausgeprägter Symptomatik ist die chirurgische Entfernung des Befunds erforderlich. Die Wahl des Zugangs wird von der Erfahrung des Operateurs und der Ausdehnung der Erkrankung bestimmt. Eine R0-Situation zu schaffen ist erstrebenswert, wobei gegebenenfalls bei Organerhalt entsprechende Kompromisse einzugehen sind. Ene radikale chirurgische Therapie führt zu einer deutlichen Symptomverbesserung, die Komplikationsrate ist relativ gering. Die chirurgische Therapie ist der medikamentösen Therapie überlegen und somit bei ausgedehnten Befunden vorzuziehen. Abstract The deep infiltrating endometriosis of the rectovaginal septum is a specific entity. Severe pelvic endometriosis frequently involves the lower recto-sigmoid colon, rectum, ureter, uterus or vagina. Symptoms associated with endometriosis depend on the location, extension and activity of the endometriotic nodule. The choice of the surgical access depends on the experience of the surgeon and on the location of the lesion. The goal of surgery is to remove all endometriotic lesions entirely. If fertility has to be conserved, reconstructive operative techniques become important and compromises may be necessary concerning the extend of surgery. Radical surgery of deep endometriosis results in a significant improvement of symptoms while the complication rate is relatively low. Surgical treatment of deep symptomatic endometriosis infiltrating the septum rectovaginale is superior to medical treatment and represents the treatment of choice. Similar content being viewed by others Author information Authors and Affiliations Additional information Electronic Publication Rights and permissions About this article Cite this article Keckstein, J., Kandolf, O., Masetti, W. et al. Die operative Therapie der tiefen Endometriose im Septum rectovaginale. Gynäkologe 35, 465–474 (2002). https://doi.org/10.1007/s00129-002-1198-0 Published: Issue date: DOI: https://doi.org/10.1007/s00129-002-1198-0

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