Laparoscopic treatment of deep pelvic endometriosis with rectal involvement

Paola De Nardi, Nadine Osman, Osman N, Stefano Ferrari, Ferrari S, Carlucci M, Michele Carlucci, Paola Persico, Persico P, Carlo Staudacher, Staudacher C, C. Staudacher
Diseases of the colon and rectum · 2009 · vol. 52(3) , pp. 419–424 · doi:10.1007/dcr.0b013e318197d716 · PMID:19333041 · W2318580784
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Laparoscopic excision of deep pelvic endometriosis involving the rectum achieved significant symptom improvement but was technically challenging, requiring laparotomy in some cases.

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This study evaluated the feasibility and outcomes of laparoscopic excision for deep pelvic endometriosis involving the rectal wall in ten patients. The surgical team, comprising gynecologists and colorectal surgeons, achieved complete excision through various resections while monitoring symptom severity via pre- and post-operative questionnaires. Although no serious complications occurred and all patients reported significant improvement in intestinal and extraintestinal symptoms, four cases required conversion to laparotomy, highlighting the technical difficulty of the procedure. This paper is centrally about endometriosis — specifically the surgical management of deep infiltrating lesions affecting the rectum.

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Abstract

PURPOSE: Our study aimed to evaluate the feasibility and outcome of laparoscopic excision of deep pelvic endometriosis with extensive rectal involvement causing severe symptoms. METHODS: Ten patients, mean age 32 years (range, 27-43), with deep pelvic endometriosis and rectal wall involvement, requiring surgical resection, were studied since January 2004. Prior to surgery and 6 months postsurgery, patients completed a 100-point rank questionnaire on intensity of intestinal and extraintestinal symptoms. A laparoscopic approach was performed by a team of a gynecologist and colorectal surgeons. RESULTS: At surgery, complete excision of infiltrating endometriosis was achieved, with 7 low rectal resections, 2 rectosigmoid resections, and 1 proctectomy with coloanal anastomosis. Additional procedures were: ureter resections (n = 2) with one reimplantation in the bladder, left ovariectomies (n = 2), ovarian endometrioma resections (n = 4), and laser ablation of superficial peritoneal lesions (n = 4). In four cases, a laparotomic conversion was needed. Mean follow-up was 27.6 months (range, 18-37). Neither intraoperative nor postoperative serious complications were observed. All the patients experienced significant improvement of intestinal and extraintestinal symptoms. CONCLUSIONS: Laparoscopic resection of deep pelvic endometriosis with rectal involvement can be successful in improving digestive and gynecologic symptoms; however, this approach is challenging with a high rate of laparotomic conversion.
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Methods

Ten patients, mean age 32 years (range, 27-43), with deep pelvic endometriosis and rectal wall involvement, requiring surgical resection, were studied since January 2004. Prior to surgery and 6 months postsurgery, patients completed a 100-point rank questionnaire on intensity of intestinal and extraintestinal symptoms. A laparoscopic approach was performed by a team of a gynecologist and colorectal surgeons.

Results

At surgery, complete excision of infiltrating endometriosis was achieved, with 7 low rectal resections, 2 rectosigmoid resections, and 1 proctectomy with coloanal anastomosis. Additional procedures were: ureter resections (n = 2) with one reimplantation in the bladder, left ovariectomies (n = 2), ovarian endometrioma resections (n = 4), and laser ablation of superficial peritoneal lesions (n = 4). In four cases, a laparotomic conversion was needed. Mean follow-up was 27.6 months (range, 18-37). Neither intraoperative nor postoperative serious complications were observed. All the patients experienced significant improvement of intestinal and extraintestinal symptoms.

Conclusions

Laparoscopic resection of deep pelvic endometriosis with rectal involvement can be successful in improving digestive and gynecologic symptoms; however, this approach is challenging with a high rate of laparotomic conversion.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Laparoscopy Laparoscopy Rectal Diseases Adult Adult Endometriosis Endometriosis Female Female Humans Humans Pelvis Pelvis Rectal Diseases Rectal Diseases Treatment Outcome Treatment Outcome

Citation neighborhood

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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