Laparoscopic Management of Rectal Endometriosis

Jatan AK, Anita Jatan, Anita K Jatan, Michael J. Solomon, Young J, Jane Young, Michael Cooper, Cooper M, Nimalan Pathma-Nathan, Nimalan Pathma‐Nathan, Pathma-Nathan N
Diseases of the colon and rectum · 2005 · vol. 49(2) , pp. 169–174 · doi:10.1007/s10350-005-0264-9 · PMID:16322961 · W1974504863
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This study reviewed 95 laparoscopic rectal endometriosis surgeries, finding that 80% were completed laparoscopically, with diathermy excision being the most common approach, and menstrual rectal pain predicted more extensive disease.

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This retrospective review analyzed outcomes for 95 patients with rectal endometriosis who underwent laparoscopic surgical intervention by a multidisciplinary team between 1996 and 2004. The study found that 80 percent of procedures were completed laparoscopically, utilizing techniques ranging from diathermy excision to segmental resection, with an overall morbidity rate of only eight percent and no anastomotic leaks. Researchers identified that menstruation-specific rectal pain and prior laparoscopy independently predicted the need for more extensive surgical approaches, while preoperative dyspareunia was the sole significant predictor of persistent postoperative symptoms. This paper is centrally about endometriosis — specifically the laparoscopic management of deep infiltrating disease involving the rectum.

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Abstract

PURPOSE: Surgical treatment of females with rectal endometriosis is challenging. The aim of this study was to review the results of laparoscopic intervention in the management of females with this complex disorder. METHOD: All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the rectum were identified and reviewed from a prospective database. RESULTS: Between April 1996 and August 2004, 95 patients with pelvic endometriosis involving the rectum had laparoscopic surgical procedures performed by one gynecologist and one colorectal surgeon. Eighty percent of rectal procedures were completed laparoscopically. Forty-three (45 percent) were treated with diathermy excision, 18 (19 percent) had shave partial-thickness disc excision, 20 (21 percent) had full-thickness disc excision (including 14 endoanally using a circular stapler), while 14 (15 percent) were managed with laparoscopic-assisted segmental low anterior resection. A history of rectal pain during defecation present only during menstruation (adjusted odds ratio=8.6, 95 percent confidence interval (CI)=1.8-41.2) and previous laparoscopy (adjusted odds ratio=3.2, 95 percent CI=1.2-8.3) independently predicted a need for more extensive surgery than diathermy excision. There were no rectal anastomotic leaks, with 8 percent overall morbidity. The only significant predictor of ongoing postoperative symptoms was a history of dyspareunia (P=0.03). CONCLUSIONS: Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.
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Method

All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the rectum were identified and reviewed from a prospective database.

Results

Between April 1996 and August 2004, 95 patients with pelvic endometriosis involving the rectum had laparoscopic surgical procedures performed by one gynecologist and one colorectal surgeon. Eighty percent of rectal procedures were completed laparoscopically. Forty-three (45 percent) were treated with diathermy excision, 18 (19 percent) had shave partial-thickness disc excision, 20 (21 percent) had full-thickness disc excision (including 14 endoanally using a circular stapler), while 14 (15 percent) were managed with laparoscopic-assisted segmental low anterior resection. A history of rectal pain during defecation present only during menstruation (adjusted odds ratio = 8.6, 95 percent confidence interval (CI) = 1.8-41.2) and previous laparoscopy (adjusted odds ratio = 3.2, 95 percent CI = 1.2-8.3) independently predicted a need for more extensive surgery than diathermy excision. There were no rectal anastomotic leaks, with 8 percent overall morbidity. The only significant predictor of ongoing postoperative symptoms was a history of dyspareunia (P= 0.03).

Conclusions

Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.

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Condition tags

endometriosischronic_pelvic_paindyspareunia

MeSH descriptors

Endometriosis Laparoscopy Rectal Diseases Adult Colectomy Defecation Endometriosis Endometriosis Feasibility Studies Female Humans Menstruation Middle Aged Pelvic Pain Pelvic Pain Rectal Diseases Rectal Diseases Retrospective Studies

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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