Laparoscopic Removal of Rectovaginal Endometriosis

Rectovaginal endometriosis (RVE) should be suspected in women presenting with a combination of dysmenorrhea, dyspareunia, deep rectal pain, and dyschezia. Several imaging tests are available with varying sensitivity and specificity to aid the diagnosis of RVE. Expectant management with periodic surveillance is a reasonable treatment option for asymptomatic women with RVE, or for women with minimal pelvic pain or bowel symptoms. Surgery for removal of rectovaginal and bowel endometriosis has been shown to be feasible, safe, and effective through either open or laparoscopic surgery. The essential steps for laparoscopic removal of RVE include appropriate port placement, mobilization of rectosigmoid adhesions, identification of the ureters, and dissection of the RVE. It also includes evaluation and removal of rectal disease based on the size, depth, location, and number of bowel lesions, and bowel integrity check following removal of endometriosis using the rectal leak test.