Aggiornamento Rectal Endometriosis
del 10-02-2012
Gynecol Obstet Fertil. 2012 Feb;40(2):116-20. Epub 2012 Jan 26.Segmental resection for colorectal endometriosis: Are there alternatives?.
[Article in French]
Daraï E, Touboul C, Chéreau E, Bazot M, Ballester M.
Source
Service de gynécologie-obstétrique, université Pierre et Marie Curie, hôpital Tenon, AP-HP, Paris 6, 4, rue de la Chine, 75020 Paris, France.
Abstract
Colorectal surgery for endometriosis is increasingly performed, but its assessment is still incomplete, especially regarding its impact on quality of life, the recurrence rate and subsequent fertility. Segmental resection is the technique most often performed and best evaluated with a proven efficacy but associated with significant morbidity. Alternatives to segmental resection consisting of shaving rectal resection, discoid resection or superficial resection have recently been proposed to provide equivalent efficacy while decreasing morbidity. To date, data are insufficient to clarify the respective indications of segmental resection and alternatives. Only randomized trials will resolve the existing controversy.
Surg Endosc. 2012 Jan 26. [Epub ahead of print]
Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial.
Ceccaroni M, Clarizia R, Bruni F, D’Urso E, Gagliardi ML, Roviglione G, Minelli L, Ruffo G.
Source
Division of Gynecologic Oncology, International School of Surgical Anatomy, Sacred Heart Hospital, “Ospedale Sacro Cuore-Don Calabria”, Via Don A.Sempreboni no. 5, 37024, Negrar, VR, Italy, issaschool@gmail.com.
Abstract
BACKGROUND:
The weight of surgical radicality, together with a lack of anatomical theoretical basis for surgery and inappropriate practical skills, can lead to serious impairments to bladder, rectal, and sexual functions after laparoscopic excision of deep infiltrating endometriosis. Although the “classical” laparoscopic technique for endometriosis excision involving segmental bowel resection has proven to relieve symptoms successfully, it is hampered by several postoperative long-term and/or definitive pelvic dysfunctions.
METHODS:
In this prospective cohort study, we compare the laparoscopic nerve-sparing approach to the classical laparoscopic procedure in a series of 126 cases. Satisfactory data for bowel, bladder, and sexual function were considered as primary endpoints.
RESULTS:
A total of 126 patients were considered for analysis: 61 treated with nerve-sparing radical excision of pelvic endometriosis with segmental bowel resection (group B), and 65 treated with the classical technique (group A). Intraoperative, perioperative, and postoperative complications were similar between the two groups. Mean days of self-catheterization were significantly lower in the nerve-sparing group (39.8 days) compared with the non-nerve-sparing group (121.1 days; p < 0.001). The relapse rate within 12 months after surgery was comparable between the two groups. Patients of group A suffered from urinary retention more frequently between 1 and 6 months (p = 0.035) compared with group B and did not experience any improvement between 6 months and 1 year (p = 0.018). Overall detection of severe bladder/rectal/sexual dysfunctions was significantly different between the two groups, and 56 patients of group A (86.2%) reported a significantly higher rate of severe neurologic pelvic dysfunctions vs. 1 patient (1.6%) of group B (p < 0.001).
CONCLUSIONS:
Our technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. Considering that this kind of surgery requires uncommon surgical skills and anatomical knowledge, we believe that it should be performed only in selected reference centers.
Minerva Med. 2012 Feb;103(1):63-72.
Urological morbidity of colorectal resection for endometriosis.
Daraï E, Zilberman S, Touboul C, Chereau E, Rouzier R, Ballester M.
Source
Service de Gynécologie-Obstétrique, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie, Paris 6, France – emile.darai@tnn.aphp.fr.
Abstract
Colorectal resection for endometriosis is a major operation exposing patients to the risk of severe digestive and urological complications. The objective of this review is to evaluate surgery-related urological morbidity of which little is known to date. We searched MEDLINE for articles published on colorectal resection for endometriosis between 1998 and March 2011 using the following terms: “bowel”, “rectal”, “colorectal”, “rectovaginal”, “rectosigmoid”, “resection” and “endometriosis”. We were not able to perform a meta- analysis due to a lack of complete data on urological complications so have focused this review on voiding dysfunction and ureteral injury. Thirty-two articles reporting on 3047 colorectal resections for endometriosis including 1930 segmental resections, 271 discoid resections and 846 rectal shavings were analysed. For voiding dysfunction, 28 series including 2563 colorectal resections were available. Postoperative voiding dysfunction varied from 0% to 30.4% with a mean value of 3.4% (73/2118). Fourteen series reported an incidence of ureterolysis comprising between 8.5% and 100% with a mean value of 46% (815/1772 patients). The risk of urinary fistulae evaluated in 26 series was estimated at 0.9% (24/2581 patients). Only one case of hydronephrosis was reported in 9 series including 1256 patients (0.07%). The incidence of urological morbidity associated with colorectal endometriosis is poorly documented and probably underestimated due to the short follow-up reported in the series. Moreover, as complication rates varied widely according to the type of surgery and the experience of the teams, further studies are required to identify risk factors of urological morbidity so as to adequately inform patients.
Acta Obstet Gynecol Scand. 2012 Jan 24. doi: 10.1111/j.1600-0412.2012.01367.x. [Epub ahead of print]
Diagnosis and treatment of rectovaginal endometriosis: An overview.
Kruse C, Seyer-Hansen M, Forman A.
Source
Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Denmark.
Abstract
Rectovaginal endometriosis can be a cause of severe pain, dyspareunia and intestinal problems. A thorough examination is needed and should include diagnostic imaging, such as transvaginal or transrectal ultrasound or magnetic resonance imaging. Medical therapies such as oral contraceptives, progestins and levonorgestrel-releasing intrauterine devices all seem to reduce pain and should always be considered. Surgical treatment is challenging and implies a risk of severe complications. Endometriotic lesions with superficial affection of the rectal wall are preferably treated with local laparoscopic excision, while segmental rectal resection is needed in case of severe intestinal infiltration.This review describes available diagnostic tools, the possibilities for medical treatment and the alternative surgical approaches.
Acta Obstet Gynecol Scand. 2012 Jan 24. doi: 10.1111/j.1600-0412.2012.01366.x. [Epub ahead of print]
Continuous low-dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography.
Ferrari S, Persico P, DI Puppo F, Vigano’ P, Tandoi I, Garavaglia E, Giardina P, Mezzi G, Candiani M.
Source
Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Università Vita-Salute San Raffaele, Milan, and Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy.
Abstract
Objective. Limited attention has been focused on the medical treatment of bowel endometriosis. This study evaluates the efficacy of a continuous low-dose oral contraceptive administration in treating pain and other symptoms associated with colorectal endometriotic nodules, as evaluated by rectal endoscopic ultrasonography. Design. Prospective observational study. Setting. Academic Department of San Raffaele Scientific Institute, Obstetrics and Gynecology Unit. Population. Symptomatic women in reproductive age (n=26) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis >50%. In 31% of the cases, endoscopic ultrasonography allowed to diagnose nodules located at more than 10 cm from the anal rim. Methods. Patients received a continuous low-dose oral contraceptive containing 15 μg ethinyl-estradiol and 60 μg gestodene for 12 months. Subjective symptoms were prospectively evaluated and nodule volumes were monitored using endoscopic ultrasonography. Results. A significant improvement in the intensity of all the considered symptoms (dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia, and painful defecation) was seen when evaluated by a visual analog scale. A reduction in terms of both diameter (mean reduction 26%) and volume (mean reduction 62%) of the nodules was observed after a 12-month period. Conclusions. A continuous low-dose oral contraceptive therapy may reduce bowel endometriosis-associated symptoms. In addition, this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography.
Fertil Steril. 2012 Jan 17. [Epub ahead of print]
Does colorectal endometriosis alter intestinal functions? A prospective manometric and questionnaire-based study.
Mabrouk M, Ferrini G, Montanari G, Di Donato N, Raimondo D, Stanghellini V, Corinaldesi R, Seracchioli R.
Source
Minimally Invasive Gynaecological Surgery Unit, S. Orsola Hospital, University of Bologna, Italy; Department of Obstetrics and Gynecology, Alexandria University, Egypt.
Abstract
OBJECTIVE:
To objectively evaluate using anorectal manometry whether endometriotic nodules influence intestinal function and to reveal subjective intestinal dysfunctions in patients with rectosigmoid deep infiltrating endometriosis.
DESIGN:
Prospective study.
SETTING:
Tertiary care university hospital.
PATIENT(S):
Patients (n = 25) with a preoperative diagnosis of rectosigmoid endometriosis.
INTERVENTION(S):
Patients underwent anorectal manometry; after that, they filled a questionnaire about defecatory functions and ranked their pain symptoms.
MAIN OUTCOME MEASURE(S):
The parameters studied were resting pressure, maximum squeezing pressure, pushing, rectoanal inhibitory reflex, and rectal sensibility. We analyzed the responses to the defecatory function questionnaire and the scored the endometriosis pain symptoms using a Visual Analogue Scale.
RESULT(S):
No alterations of the rectoanal inhibitory reflex were found. Hypertone of the internal anal sphincter was found in 20 of 25 patients. Almost half of the patients had an increase of the threshold of desire to defecate, and 7 patients had a reduction of the anal sphincter squeeze pressure. According to the responses to the defecatory function questionnaire, incomplete evacuation was the most common symptom.
CONCLUSION(S):
We did not find marked motility or sensitive dysfunctions at the anorectal manometry, whereas subjectively patients reported some defecatory disorders. We revealed the presence of hypertone of the internal anal sphincter in most of the patients. CLINICAL
TRIAL REGISTRATION NUMBER:
74/2010/O/Sper.
Ultrasound Obstet Gynecol. 2012 Jan 17. doi: 10.1002/uog.11102. [Epub ahead of print]
Comparison between transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis.
Saccardi C, Cosmi E, Borghero A, Alberto T, Dessole S, Litta P.
Source
Department of Gynaecological Sciences and Human Reproduction. University of Padova, Padova, Italy; Department of Gynaecological and Obstetrical Sciences and Neonatology, University of Parma, Parma, Italy. carlosaccardi@yahoo.it.
Abstract
Objective: to compare clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep pelvic endometriosis. Methods: women suspected of having posterior deep pelvic endometriosis on the basis of subjective symptoms and clinical evaluation, underwent clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging. Laparoscopy was performed and specimens were sent to histological examination. Sensitivity, specificity, positive and negative predictive value, as well as positive and negative likelihood ratios was analysed for every diagnostic method. Results: Fifty-four patients out of 102 women suspected of having posterior DPE underwent laparoscopic surgery. Among these, in 46 (85.2%) cases DPE was confirmed at laparoscopic and histological examination. Sonovaginography correctly identified 43 (93.5%) cases, presenting higher accuracy compared to other procedures. Sonovaginography and even magnetic resonance imaging were more accurate in diagnosing and discriminating the different localizations of endometriotic lesions, with sensibility respectively of 94.7% and 73.1% for vaginal fornix, 88.9% and 66.7% for utero-sacral ligaments, and 80.6% and 83.3% for recto-vaginal septum involvement; Specificity of sonovaginography and MRI was respectively of 97.1% and 94.3% for vaginal fornix, 95.6% and 95.6% for utero-sacral ligaments, and 100% and 77.8% for recto-vaginal septum involvement. In the diagnosis of rectal endometriosis, we found mean values of sensibility, 66.7% for both the two techniques and specificity of 93.8% and 95.8%, for sonovaginography and magnetic resonance imaging, respectively. Conclusions: transvaginal ultrasound should be used as first-line diagnostic techniques and both sonovaginography and/or magnetic resonance imaging as second-line methods in the diagnosis of deep pelvic endometriosis. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Hum Reprod. 2012 Jan 11. [Epub ahead of print]
Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results.
Ercoli A, D’asta M, Fagotti A, Fanfani F, Romano F, Baldazzi G, Salerno MG, Scambia G.
Source
Department of Gynecology, Policlinico Abano Terme, Piazza Cristoforo Colombo, 1- 35031 Abano Terme (PD), Italy.
Abstract
BACKGROUNDDeep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery.METHODSFrom March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale.RESULTSThere were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters.CONCLUSIONSTo our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy.
AJR Am J Roentgenol. 2012 Jan;198(1):98-105.
CT antegrade colonography to assess proctectomy and temporary diverting ileostomy complications before early ileostomy takedown in patients with low rectal endometriosis.
Gouya H, Oudjit A, Leconte M, Coste J, Vignaux O, Dousset B, Legmann P.
Source
Department of Radiology, University Paris Descartes Paris V, Cochin Hospital, Assistance Publique Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, Cedex 14, France. martinjeang@yahoo.fr
Abstract
OBJECTIVE:
The purpose of this study is to describe an imaging method based on a CT technique, CT antegrade colonography, for the evaluation of low anastomosis and to evaluate the value of CT antegrade colonography before early ileostomy closure after proctectomy in low rectal endometriosis.
MATERIALS AND METHODS:
One hundred ninety-five patients referred for low rectal endometriosis underwent proctectomy and were eligible for early ileostomy closure. All patients underwent standard antegrade fluoroscopy (n=77) or CT antegrade colonography (n=118) 8 days after surgery. The negative predictive values, positive predictive values, sensitivity, specificity, and likelihood ratio of standard antegrade fluoroscopy and CT antegrade colonography in detecting anastomotic leakage and abscesses were assessed. The reference standard for positive and negative examinations was based on clinical follow-up, imaging, surgical, or interventional procedure findings.
RESULTS:
Negative and positive predictive values for detecting anastomotic leakage were 100% (95% CI, 96.8-100%) and 100% (95% CI, 39.8-100%), respectively, for CT antegrade colonography and 98.6% (95% CI, 92.4-100%) and 100% (95% CI, 54.1-100%), respectively, for standard antegrade fluoroscopy. The negative and positive predictive values for detecting abscess were 100% (95% CI, 96.8-100%) and 100% (95% CI, 47.8-100%), respectively, for CT antegrade colonography and 97.3% (95% CI, 90.8-99.7%) and 100% (95% CI, 2.5-100%), respectively, for standard antegrade fluoroscopy.
CONCLUSION:
CT antegrade colonography may play a major role in the evaluation of low anastomosis protected by an ileostomy after proctectomy in low rectal endometriosis, leading to the development of a new strategy with early restoration of the intestinal continuity.
Pan Afr Med J. 2011;10:33. Epub 2011 Nov 8.
Exceptional cause of bowel obstruction: rectal endometriosis mimicking carcinoma of Rectum – a case report.
Sassi S, Bouassida M, Touinsi H, Mongi Mighri M, Baccari S, Chebbi F, Bouzeidi K, Sassi S.
Source
Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia.
Abstract
Endometriosis with intestinal serosal involvement is not uncommon in women of childbearing age. However, endometriosis presenting as colon obstruction is rare and occurs in less than 1% of cases. The Lack of pathognomonic signs makes the diagnosis difficult, mostly because the main differential diagnosis is with neoplasm, even during the intervention. Reported here is a case of a 35-year -old woman presenting with bowel obstruction due to rectal endometriosis. The patient presented signs and symptoms of bowel obstruction. Colonoscopy and radiological findings were suggestive of rectal carcinoma. Surgeons performed an anterior resection with right salpingectomy. Histopathology diagnosed bowel endometriosis. This case demonstrates the difficulty of establishing an accurate pre- and intra- operative diagnosis and the ability of intestinal endometriosis to mimic colon cancer.
J Laparoendosc Adv Surg Tech A. 2012 Jan;22(1):66-9. Epub 2011 Dec 13.
Laparoscopic rectal resection of deep infiltrating endometriosis.
Jelenc F, Ribič-Pucelj M, Juvan R, Kobal B, Sinkovec J, Salamun V.
Source
1 Department of Abdominal Surgery, University Medical Centre Ljubljana , Ljubljana, Slovenia .
Abstract
Abstract Purpose: Deep infiltrating endometriosis with colorectal involvement is a complex disorder, often requiring segmental bowel resection. Complete removal of all visible lesions is considered the adequate treatment of infiltrating endometriosis in order to reduce recurrence. In this article, we describe our experience with laparoscopic management of deep infiltrating endometriosis with involvement of the rectum. Methods: A retrospective analysis of data from patients with deep infiltrating endometriosis with rectal involvement who underwent a laparoscopic surgery in the years 2002-2009 at the Department of Obstetrics and Gynecology at our institution was done. Results: Between 2002 and 2009, a laparoscopic partial rectal resection was performed in 52 patients, and laparoscopic disk resection was performed in 4 cases with deep infiltrating endometriosis. The mean age of patients was 34.4 years (range, 22-62 years). Preoperative symptoms included dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The laparoscopic procedure was converted to formal laparotomy in 3 patients (5.4%). The mean duration of surgery was 145 minutes. Postoperative complications included 3 cases of anastomotic leakage with rectovaginal fistula in two cases and intraabdominal bleeding in 1 case. The mean hospital stay was 7 days. Postoperatively, nine patients had a normal delivery, two of them after in vitro fertilization treatment. Conclusion: Laparoscopic rectal resection for deep infiltrating endometriosis is a relatively safe procedure, when performed by a surgeon and a gynecologist with sufficient experience in laparoscopic colorectal surgery.
Hum Reprod. 2012 Feb;27(2):418-26. Epub 2011 Dec 8.
Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum.
Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ.
Source
Department of Digestive Surgery, Rouen University Hospital, Rouen , France.
Abstract
BACKGROUND Two surgical approaches are employed in the treatment of deep infiltrating endometriosis of the rectum (DIER): colorectal resection and nodule excision. In 2009, we introduced a new technique for transanal full thickness disc excision of endometriotic nodules infiltrating the low and middle rectum, using the Contour(®) Transtar(™) stapler (Ethicon Endo-Surgery inc., Cincinnati, OH, USA). The aim of this retrospective study was to describe the technique and to present data on the feasibility of this technique. METHODS From April 2009 to October 2010, all patients presenting with DIER and undergoing full thickness excision using the Contour(®) Transtar(™) stapler were enrolled in the study. Pre-, intra- and post-operative data were collected and reported. RESULTS Six nulliparous women were managed using this technique during the study period. The rectal wall discs removed measured from 40 × 45 to 60 × 50 mm. In two cases, microscopic foci were noted on one of the margins but in four cases the limits were clear. Operating time varied from 180 to 450 min. Four women were completely free of post-operative digestive complaints. CONCLUSIONS Despite the small numbers in this series, our data suggest that the new technique of transanal rectal disc excision using the contour stapler may be applied in patients with infiltrating endometrial nodules of the rectum up to 10 cm from the anal margin and up to 5 cm in diameter. This new procedure promises to be a useful addition to the surgeon’s armamentarium in a multidisciplinary approach to deep pelvic endometriosis.
Int J Surg Case Rep. 2011;2(6):150-3. Epub 2011 Apr 15.
Perineal scar endometriosis ten years after Miles’ procedure for rectal cancer: Case report and review of the literature.
Cinardi N, Franco S, Centonze D, Giannone G.
Source
Surgical Oncology Unit, Department of Oncology, Garibaldi-Nesima Hospital, Via Palermo 636, 95122 Catania, Italy.
Abstract
Endometriosis within a perineal scar after a Miles’ procedure has not been previously reported in literature. We report a case of a 35-year-old-female who was treated 10 years before at the same institution for a low rectal cancer that presents with two discrete subcutaneous bulges within her perineal wound. Since the patient was asymptomatic and the complete work up for recurrent disease showed no evidence of malignancy, first line therapy was conservative. After two pregnancies and a caesarean section, the patient presented at our observation with enlarged and tender perineal nodules. The patient was treated with a wide excision of the perineal scar en-bloc with the nodules. Final pathology report was consistent with scar endometriosis.
BJOG. 2011 Dec;118(13):1678; author reply 1678-9. doi: 10.1111/j.1471-0528.2011.03162.x.
Complications after surgery for deeply infiltrating pelvic endometriosis.
Padavala J, Navaneetham N.
Comment on
- BJOG. 2011 Feb;118(3):292-8.
J Gynecol Obstet Biol Reprod (Paris). 2011 Nov 7. [Epub ahead of print]
Laparoscopic colorectal resection for deep pelvic endometriosis: Evaluation of post-operative outcome.
[Article in French]
Boileau L, Laporte S, Bourgaux JF, Rouanet JP, Filleron T, Mares P, de Tayrac R.
Source
Service de gynécologie et d’obstétrique, CHU de Nîmes, place du Pr R.-Debré, 30029 Nîmes, France.
Abstract
OBJECTIVES:
Evaluation of mid-term functional results and the quality of life after laparoscopic colorectal resection.
PATIENTS AND METHODS:
Twenty-three consecutive patients were included in a retrospective monocentric study. Postoperative functional outcomes and quality of life were analyzed.
RESULTS:
The median follow-up after colorectal resection was of 24±15.7 months (6-72). Major complications occurred in three cases (12,9%) including one anastomotic stenosis, one digestive and one bladder fistula. A significant improvement in pelvic pain symptoms was observed. De novo constipation and pain on defecation occurred in respectively 23% and 42% of the cases. Transient de novo dysuria occurred in 18% of the cases. The quality of life has been significantly improved.
CONCLUSION:
Laparoscopic colorectal resection is associated with unfavourable postoperative digestive and urological outcomes, such as bladder and rectal dysfunction. Radical treatment should be limited to selected patients.
Rev Gastroenterol Mex. 2011 Jul-Sep;76(3):247-8.
Laparoscopic low anterior resection for rectal endometriosis.
[Article in Spanish]
Rodríguez-Zentner H, Ríos JL, Flamarique A.
Source
Cirujano colorrectal, Jefe de Docencia.
Surg Endosc. 2011 Oct 25. [Epub ahead of print]
Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results.
Ruffo G, Sartori A, Crippa S, Partelli S, Barugola G, Manzoni A, Steinasserer M, Minelli L, Falconi M.
Source
Department of General Surgery, Ospedale “Sacro Cuore-Don Calabria”, Via Sempreboni 5, 37024, Negrar, VR, Italy, giacomo.ruffo@sacrocuore.it.
Abstract
BACKGROUND:
Although several studies have shown that laparoscopic resection is safe and feasible in bowel endometriosis, limited data are available on the specific treatment for endometriosis of the rectum. The aim of this study is to describe operative and postoperative outcomes after laparoscopic resection of the mid/low rectum for endometriosis.
METHODS:
Between 2002 and 2010, 750 patients (median age 33 years) underwent laparoscopic resection of the mid/low rectum for deep infiltrating endometriosis at a single institution. All operations were performed with a standardized technique by a single surgeon.
RESULTS:
Median operative time was 255 min, and median blood loss 150 ml. Of patients, 7% required blood transfusions. Laparotomic conversion rate was 1.6%. Mechanical low and very low colorectal anastomoses were carried out in 92.5 and 7.5% of patients, respectively. Temporary ileostomy rate was 14.5%. Median length of stay was 8 days. Overall surgical morbidity was 9% with no mortality. Rates of anastomotic leak, rectovaginal fistula, and intraabdominal bleeding were 3, 2, and 1.2%. Forty patients (5.5%) required reoperation.
CONCLUSIONS:
Laparoscopic resection of the mid/low rectum for endometriosis can be performed safely with acceptable rates of morbidity/reoperation and with low rates of specific complications, including anastomotic leak and rectovaginal fistula. The very high surgical volume of the operating surgeon is probably one of the most important factors in order to maximize postoperative outcomes.
Taiwan J Obstet Gynecol. 2011 Sep;50(3):375-6.
Rectum penetration that was caused by the displacement of an intrauterine device and mimicked rectal endometriosis.
Weng SF, Chen HS, Chen YH, Lee JN, Tsai EM.
Presse Med. 2011 Oct 18. [Epub ahead of print]
Intestinal endometriosis.
[Article in French]
Leconte M, Borghese B, Chapron C, Dousset B.
Source
AP-HP, hôpital Cochin, université Paris-Descartes, service de chirurgie digestive, hépatobiliaire et endocrinienne, 75679 Paris cedex 14, France.
Abstract
Endometriosis affects 6 to 10 % of all women of childbearing age. Intestinal involvement is defined by muscularis infiltration and has been estimated to occur in 8 % to 12 % of women with endometriosis. The most common sites are rectum, sigmoid and ileocaecal junction. In most cases, intestinal endometriosis is associated with deep infiltrating endometriosis, multifocal and aggressive form of endometriosis, responsible for refractory pelvic pain and infertility. The symptoms are nonspecific but are characterized by cyclic exacerbation of pain. The preoperative work-up includes a rectal endoscopic ultrasonography, a transvaginal ultrasonography, a pelvic magnetic resonance imaging and a multidetector CT scan. There is currently no cure other than surgical removal of lesions. Medical treatments are based on a hormone used to block ovarian function.
JSLS. 2011 Jul-Sep;15(3):331-8.
Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis.
Moawad NS, Guido R, Ramanathan R, Mansuria S, Lee T.
Source
Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA. nmoawad@ufl.edu
Abstract
OBJECTIVE:
To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR).
METHODS:
This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital. Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared.
RESULTS:
Twenty-two patients underwent laparoscopic ADR (n
CONCLUSION:
ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.
Srp Arh Celok Lek. 2011 Jul-Aug;139(7-8):531-5.
Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: a case report.
Sparić R, Hudelist G, Keckstein J.
Source
Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia. radmila@rcub.bg.ac.rs
Abstract
INTRODUCTION:
Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis.
CASE OUTLINE:
We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel.
CONCLUSION:
Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation.The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.