Bowel resection for severe endometriosis: An Australian series of 177 cases

Abstract

Our study adds to the growing body of literature describing colorectal resection for severe endometriosis. Overall, the surgery appeared to be well tolerated, demonstrating the role for this surgery.

Abdominopelvic Complications of Endometriosis

“…Endometriosis affects the gastrointestinal tract of 5-12% of women with this condition (Wills et al, 2009). The rectum and the rectosigmoid junction are the most common sites of bowel endometriosis (70-93% of all bowel lesions).…”

“…The other approach is to decide during surgery based on findings such as the size, localisation and extension of the disease. Laparoscopic conversion rates is from 0% to 13%, due to extent of disease, dense adhesions, bowel perforation, difficulty stapling a bowel anastomosis, bleeding and poor visualisation (Wills et al, 2009).…”

“…The low percentage of rectal endometriosis extending to the mucosa means colonoscopy has too low a sensitivity to be a reliable test for rectal involvement. Preoperative colonoscopy should be performed on an individualised basis to exclude other pathology and suspicious mucosal lesions should be biopsied to exclude malignancy (Wills et al, 2009). Endorectal ultrasound has shown a sensitivity of more than 90% for rectovaginal septum endometriosis and a lower specifity for rectal wall invasion.…”

“…The nodule can be shaved off the rectal wall leaving it intact if superficial serosal deposits are present, alternatively if there is a solitary penetrating nodule there may be the opportunity to perform a fullthickness disc resection of the rectal wall, or it may be necessary to consider a segmental resection of the rectum and/or sigmoid colon (Brouwer & Woods, 2007;Wills et al, 2009). All these procedures can be carried out by either a laparoscopic, combined or open approach (Brouwer & Woods, 2007;Dousset et al, 2010;Wills et al, 2009). Robotic assistance may allow more bowel resections to be carried out by laparoscopy (Veeraswamy et al, 2010).…”

Response to Dennerstein letter: Bowel resection for severe endometriosis: an Australian series of 177 cases

“…2 Firstly, he appears to consider the necessity for bowel resection in cases of endometriosis involving the bowel is rare. We disagree.…”