Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis

Nezhat C, C Nezhat, Camran Nezhat, Farr Nezhat, F Nezhat, Nezhat F, E Pennington, Earl Pennington, Pennington E, Nezhat CH, C H Nezhat, Wayne L. Ambroze, W Ambroze, Ambroze W
Surgical endoscopy · 1994 · vol. 8(6) , pp. 682–685 · doi:10.1007/bf00678566 · PMID:8059307 · W2329663919
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

This study evaluated a laparoscopic technique for bowel endometriosis, finding complete symptom relief in six of eight patients within 5-18 months post-surgery, with well-healed anastomotic sites.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper describes a small case series of eight women aged 29–38 with extensive symptomatic infiltrative intestinal (full-thickness bowel) endometriosis who had not responded to prior conservative surgical and hormonal therapy and were treated using a laparoscopic disk excision of the anterior rectal wall with primary repair. At 5–18 months of follow-up, six reported complete relief of symptoms, two had residual right lower quadrant pain and menstrual cramping, and one infertility patient achieved pregnancy; only one complication (anterior abdominal wall ecchymosis) was reported. The authors note that second-look laparoscopy was offered to all patients and only two accepted, and they used sigmoidoscopy at about 6 weeks and up to 6 months to assess healing, with no stricture seen to date, but longer-term outcomes in a larger cohort were not addressed. This paper is centrally about endometriosis — laparoscopic anterior rectal wall disk excision with primary repair for full-thickness bowel endometriosis.

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Abstract

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29-38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5-18-month postoperative followup, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complications was one patient with ecchymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.
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Abstract

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29–38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5–18-month postoperative followup, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complication was one patient with ecchymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis. Similar content being viewed by others

References

Cattell RB (1987) Endometriosis of the colon and rectum with intestinal obstruction. N Engl J Med 217: 9–16 Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdes CT (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53: 411–416 Forsgren H, Lindhagen J, Melander S (1983) Colorectal endometriosis. Acta Chir Scand 149: 431–435 Meyers WC, Kelvin FM, Jones RS (1979) Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 114: 169–175 Nezhat C, Pennington E, Nezhat F, Silfen SL (1991) Laparoscopically assisted anterior rectal wall resection and reanastomosis for deeply infiltrating endometriosis. Surg Laparosc Endosc 1: 2: 106–108 Nezhat F, Nezhat C, Pennington E (1992) Laparoscopic proctectomy for infiltrating endometriosis of the rectum. Fertil Steril 57: 1129–1132 Nezhat F, Nezhat C, Pennington E, Ambroze W (1992) Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: a preliminary report. Surg Laparosc Endosc 2: 212–216 Nezhat C, Nezhat F, Nezhat C (1992) Operative laparoscopy (minimally invasive surgery): state of the art. J Gynecol Surg 8: 111–141 Nezhat C, Nezhat F, Pennington E (1992) Laparoscopic treatment of lower colorectal and infiltrative rectovaginal septum endometriosis by the technique of videolaseroscopy. Br J Obstet Gynaecol 99: 664–667 Prystowsky JB, Stryker SJ, Ujiki GT (1988) Gastrointestinal endometriosis. Arch Surge 123: 855–858 Sabiston DC (ed) (1991) The biological basis of modern surgical practice, 14th ed. Saunders, Philadelphia Samper ER, Slagle GW, Hand AM (1984) Colonic endometriosis: Its clinical spectrum. South Med J 77: 912–914 Author information Authors and Affiliations Rights and permissions About this article Cite this article Nezhat, C., Nezhat, F., Pennington, E. et al. Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis. Surg Endosc 8, 682–685 (1994). https://doi.org/10.1007/BF00678566 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF00678566

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Laparoscopy Rectal Diseases Adult Anastomosis, Surgical Colon Colon Colonic Diseases Colonic Diseases Colonic Diseases Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Humans Laparoscopy Rectal Diseases Rectal Diseases

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