Sample All women given surgical treatment for deep endometriosis.Methods Women who underwent surgery for deep endometriosis were reviewed for intra-and postoperative complications.Main outcome measures Primary outcomes were rates of intraand postoperative complications. Complications were compared according to the procedure performed.Results A total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P < 0.01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004).Conclusions Surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.

Results of clinical applications of NOTES in the IMTN Study showed the feasibility of different methods of this new minimally invasive alternative for laparoscopic and open surgery.

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Vancomycin has been used with increased frequency during the past 15 years and the most common toxicity with this drug is the red man syndrome . Other adverse effects include neutropenia, fever, phlebitis, nephrotoxicity, ototoxicity, thrombocytopenia, interstitial nephritis, lacrimation, linear IgA bullous dermatosis, necrotizing cutaneous vasculitis and toxic epidermal necrolysis. Only two cases of vancomycin-induced Stevens-Johnson syndrome and one case of pancytopenia have been reported in the medical literature. The treatment for both situations is based on cessation of the vancomycin therapy; in cases of Stevens-Johnson syndrome, antihistamine and/or steroid agents can be used. This article reports a case of pancytopenia and a case of erythema major associated with neutropenia.

Major postoperative complications were reduced by using the reverse technique.

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The localization and severity of endometriotic lesions and adhesions, as described using the #Enzian classification for endometriosis, can be diagnosed accurately on preoperative ultrasound. What are the clinical implications of this work?The recently updated #Enzian classification can be applied accurately both at preoperative ultrasound examination and during surgical resection of endometriosis, thereby enabling the use of uniform terminology for describing endometriosis.