Laparoscopic Mobilization of the Rectosigmoid and Excision of the Obliterated Cul-de-sac

Hollett-Caines J, Jackie Hollett-Caines, George A. Vilos, Vilos GA, Deborah Anne Penava, Penava DA, Deborah Penava
The Journal of the American Association of Gynecologic Laparoscopists · 2003 · vol. 10(2) , pp. 190–194 · doi:10.1016/s1074-3804(05)60297-6 · PMID:12732770 · W2147548103
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This paper describes the technique for laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac to manage pelvic adhesions and improve surgical outcomes.

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Abstract

Study objectiveTo evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac.DesignRetrospective cohort (Canadian Task Force classification II-2).SettingUniversity-affiliated teaching hospital.PatientsEighty-one women with infertility and/or chronic pelvic pain. Intervention. Laparoscopic excision of all endometrial implants and uterosacral ligaments, and dissection of the cul-de-sac using a horseshoe-shaped approach to mobilize, but not resect, the rectosigmoid.Measurements and main outcomesEleven women (24%) had endometriomas. Cumulative pregnancy rates in 34 women with primary infertility and 12 with secondary infertility were 62% and 42%, respectively. Eighty-eight percent of 61 women with pain reported significant improvement of symptoms.ConclusionLaparoscopic excision of cul-de-sac and rectovaginal endometriosis by this approach is feasible and safe when performed by an experienced surgeon, and results in high rates of cumulative pregnancy and relief of pain. Some patient variables may give higher rates of success for pregnancy than others.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Douglas' Pouch Endometriosis Intestinal Diseases Laparoscopy Adolescent Adult Colon, Sigmoid Colon, Sigmoid Douglas' Pouch Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Humans Hysterectomy Hysterectomy Infertility, Female Infertility, Female Infertility, Female

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License: CC0 · commercial use OK