Multidisciplinary surgical management of severe posterior compartment endometriosis

Background Endometriosis is a chronic, infammatory, and hormone-dependent disease that afects approximately 10% of \nwomen in reproductive age. Endometriosis is categorized into diferent types, as superfcial, deep, and ovarian endometriosis. \nWhen deep endometriosis occurs, the sigmoid and rectum are often afected (Becker et al. in Hum Reprod Open, 2022, \nhttps://doi.org/10.1093/hropen/hoac009). In the following article, we aim to demonstrate stepwise surgery for stage IV \nendometriosis involving the anterior rectosigmoid. \nMethods We present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment \nendometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate \nincorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, \ninterdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned. \nResults The total laparoscopic approach is demonstrated step by step in the video. \nConclusions Deep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, \npreoperative endometriosis-specifc imaging should be performed for optimal surgical planning. Experienced endometriosis \nmultidisciplinary surgical teams can provide specialized and high-quality care for patients sufering from this debilitating \ndisease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X).