Laparoscopic resection of deeply infiltrating endometriosis of the rectovaginal septum: effect on pelvic pain

Abstract

Objective To compare pain scores for dysmenorrhoea, intermenstrual pelvic pain, dyspareunia and dyschezia before and after resection of endometriotic nodules from the rectovaginal septum. Design Retrospective review of case records in 46 patients who had resection of deeply infiltrating endometriotic nodules from the rectovaginal septum. Adhesiolysis and treatment of endometriomas were performed where necessary. Two patients underwent laparoscopic uterosacral nerve ablation. Results The average patient age was 32 years. The presenting symptoms were: severe dysmenorrhoea (70%), pelvic pain (65%), dyspareunia (28%), dyschezia (30%) and infertility (28%). Improvements in pain scores at follow up (mean 8.8 months) were 59%, 87%, 77% and 86%. Only one of the 13 patients with infertility conceived in the follow‐up period. Conclusion This retrospective analysis suggests that the laparoscopic resection of rectovaginal endometriosis is effective in improving the different facets of pelvic pain. We believe that the development of a standardized scoring system to assess pain resulting from endometriosis would be helpful, as well as prospective studies to evaluate different treatment modalities.

Laparoscopic laser resection of rectovaginal pouch and rectovaginal septum endometriosis: the impact on pelvic pain and quality of life

“…In our study, the recurrence rate was 19% (5 needed further surgery when all the endometriosis was removed, 10%), and 4 had objective signs of recurrence, but their symptoms were relatively mild so an operation was not indicated. This is in agreement with others (4, 7), (16, 20).…”

“…For treatment of deep endometriosis, different techniques have been described, such as laparoscopy, laparotomy, vaginal or expectant management (4), (14–18). Additionally, several surgical approaches have been used: radical pelvic surgery, local resection, laparoscopic uterosacral nerve ablation (LUNA) and laser or diathermy ablation.…”