A Surgery on Deep Infiltrating Endometriosis Involving the Rectum: A Debate Started 100 Years Ago between Cullen and Sampson

Abstract

A recent randomized control trial reports at the 5 years postoperative stage for limited vs extended surgery involving the rectovaginal septum. For those gynecologists with advanced laparoscopy skills who have been reluctant to embrace the idea of complete bowel resections with reanastomosis, the study provides comfort in showing no difference in long-term outcomes between nodule excision and rectal resection. However, the study perpetuates the idea that all medical procedures have to be subjected to this type of statistical analysis, without any reference to the pioneers whose ideas formed the basis of current procedures as well as providing an understanding of the pathogenesis of the underlying disorder. The two gynecologists who first reported on the surgical management of this condition 100 years ago projected different ideas on pathogenesis as well as the appropriate surgical method to apply. Thomas Cullen and John Sampson should be acknowledged in any consideration of determining the appropriate procedure for this challenging disorder.