[Laparoscopic therapy of intestinal endometriosis and the ranking of drug treatment]

Patients with severe endometriosis involving the rectovaginal septum and bowel makes surgery necessary. The laparoscopic approach offers the possibility to perform the complete resection with minimal invasiv techniques. Small lesions can be removed by full-thickness-resection. Large nodules make a segmental resection necessary. Deep lesions are resected with stapling devices. Nodules in the sigmoid ore removed by laparoscopic assisted hand-sewn anastomosis.

Between 3/96 and 7/03 142 patients with severe endometriosis involving the bowel have been treated laparoscopically. The pre-operative complains have been reduced as following: dyschezio: 88 %, dyspareunia 87 %, chronic pelvic pain 96 %, disturbance of sexuality 75 %. The complication rate was minimal: leakage of the anastomosis n=4 (2,8 %), paraproctial abscess 2 (1,4 %), blood transfusion 1 (0,7 %), severe stenosis of the anastomosis 6 (4,2 %).

Laparoscopic approach is a safe and effective technique to treat deep infiltrating endometriosis with bowel involvement. The hormonal treatment of bowel endometriosis is used in patients with minimal symptoms. The postoperative treatment becomes necessary in incomplete operations or in patients with severe adenomyosis and infertility. Schlüsselwörter Darmendometriose - laparoskopische Resektion - Langzeit-Follow-up - medikamentöse Therapie Key words Bowel endometriosis - laparoscopic treatment - longtime follow-up - hormonal treatment Literatur - 1 Bailey H R, Ott M T, Hartendorp P. Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum. 1994; 37 747-753 - 2 Busacca M, Bianchi S, Agnoli B, Candiani M, Calia C, De Marinis S, Vignali M. Follow-up of laparoscopic treatment of stage III-IV endometriosis. J Am Assoc Gynecol Laparosc. 1999; 6 55-58 - 3 Chapron C, Dubuisson J B, Tardif D, Decoret E. 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Surg Laparosc Endosc. 1992; 2 120-124 Dr. Prim. Univ.-Prof. Jörg Keckstein Landeskrankenhaus Villach Abtlg. für Gynäkologie und Geburtshilfe Nikolaigasse 43 9500 Villach Phone: 0 42 42-2 08-23 92 Fax: 0 42 42-2 08-23 07 Email: [email protected]