Laparoscopic management of colorectal endometriosis

B. L. Jerby, Jerby BL, H Kessler, Kessler H, Hermann Keßler, Falcone T, T. Falcone, J. W. Milsom, Milsom JW, Jeffrey W. Milsom
Surgical endoscopy · 1999 · vol. 13(11) , pp. 1125–1128 · doi:10.1007/s004649901187 · PMID:10556452 · W2084352183
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This study evaluated the laparoscopic management of colorectal endometriosis in 30 patients, finding it safe, feasible, and effective, with most advanced cases requiring disc excision or bowel resection.

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This study prospectively evaluated 509 consecutive patients with endometriosis undergoing laparoscopic intervention at a tertiary referral center (1994–1998), analyzing the subset with colorectal involvement for disease stage, procedures, operative time, conversion rate, hospital length of stay, and complications. Colorectal involvement was identified in 30 patients (5.9%), with 28 having stage IV disease; preoperative suspicion occurred in 13, and treatments included superficial excision (12), protectomy/proctosigmoidectomy (7), and rectal disc excision (5), with conversion to conventional surgery required in 4 due to overall pelvic severity. For patients undergoing full-thickness excision/resection (n=12) versus less extensive surgery (n=18), median operative time was 180 vs 110 minutes and median hospitalization was 4 vs 1 day, and one major complication (colovaginal fistula) occurred. The authors conclude laparoscopic management of colorectal endometriosis is safe, feasible, and effective in nearly all patients, with outcomes assessed at a median follow-up of 10 months (range 1–32). This paper is centrally about endometriosis — laparoscopic management strategies and outcomes for colorectal endometriosis.

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Abstract

BackgroundIn the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery. The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center.MethodsFrom November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively evaluated. Those with colorectal involvement were analyzed for stage of disease, procedure, operative time, conversion rate, length of hospitalization, and complications.ResultsIn 30 of the 509 patients (5.9%), colorectal involvement was identified. Twenty-eight of these 30 had stage IV disease. Intestinal involvement was suspected preoperatively in 13 of 30. Twelve required superficial excision of colon or rectal endometriomas. Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patients. Four cases required conversion due to the overall severity of the pelvic disease. For those who did (n = 12) and did not (n = 18) require full-thickness excisions/resections, the median operative time was 180 min (range, 90-390) and 110 min (range, 45-355), respectively; the median length of hospitalization was 4 days (range, 3-7) and 1 day (range, 0-4), respectively. A major complication occurred in one patient (colovaginal fistula). At a median follow-up of 10 months (range 1-32), 28 patients were improved, and 24 of these had near or total resolution of preoperative symptoms.ConclusionsExtensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients.
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Abstract

Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery. The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center.

Methods

From November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively evaluated. Those with colorectal involvement were analyzed for stage of disease, procedure, operative time, conversion rate, length of hospitalization, and complications.

Results

In 30 of the 509 patients (5.9%), colorectal involvement was identified. Twenty-eight of these 30 had stage IV disease. Intestinal involvement was suspected preoperatively in 13 of 30. Twelve required superficial excision of colon or rectal endometriomas. Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patients. Four cases required conversion due to the overall severity of the pelvic disease. For those who did (n= 12) and did not (n= 18) require full-thickness excisions/resections, the median operative time was 180 min (range, 90–390) and 110 min (range, 45–355), respectively; the median length of hospitalization was 4 days (range, 3–7) and 1 day (range, 0–4), respectively. A major complication occurred in one patient (colovaginal fistula). At a median follow-up of 10 months (range 1–32), 28 patients were improved, and 24 of these had near or total resolution of preoperative symptoms.

Conclusions

Extensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients. Similar content being viewed by others Author information Authors and Affiliations Additional information Received: 1 April 1998/Accepted: 22 March 1999 Rights and permissions About this article Cite this article Jerby, B., Kessler, H., Falcone, T. et al. Laparoscopic management of colorectal endometriosis. Surg Endosc 13, 1125–1128 (1999). https://doi.org/10.1007/s004649901187 Published: Issue date: DOI: https://doi.org/10.1007/s004649901187

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Diseases Laparoscopy Adult Endometriosis Female Fertility Humans Intestinal Diseases Laparoscopy Middle Aged Prospective Studies

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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