Laparoscopic resection of intestinal endometriosis: A 5-year experience

Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis

“…Twenty-five percent of the cases in the laparoscopy group were converted to laparotomy. This is higher than the 7.8% reported in a literature review of women requiring colorectal resection for endometriosis [12][13][14][15][42][43][44][45][46]. Our relatively high incidence of conversion cannot be exclusively explained by the addition of hysterectomy to colorectal resection but by the inclusion of patients with high incidence of previous surgery for the same disorder and the presence of multiple locations of endometriosis.…”

“…In contrast to laparoscopic surgery for deep infiltrating endometriosis (DIE), few data are available on quality of life after extensive surgery for endometriosis [18]. It has been shown using validated questionnaires that laparoscopic treatment of DIE leads to improvement in quality of life [41,43]. For the whole population, apart from physical functioning, all items of the SF-36 questionnaire were improved by surgery.…”

Surgical treatment of rectovaginal endometriosis with rectal involvement

“…There were also five nonsystematic revisions published [3,28,[32][33][34]. In some of the studies, a radical treatment was assessed [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], while others assessed a conservative one [57][58][59][60][61][62][63]. There were six nonrandomized papers in which groups of patients with different therapeutic options were compared [30,[35][36][37][38][39].…”

“…Initially, the majority of papers defended a conservative surgical approach directed toward the extirpation or ablation of the endometriosic lesions with minimal excisional surgery of the rectum [6,12,[65][66][67][68]. However, in the last decade, multiple authors have proposed more aggressive techniques including intestinal resection, especially in those cases with an affected muscularis propia of the rectum but also in those having an intact mucosa [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. The argument used for the practice of this radical surgery is that of achieving the greatest resection possible of the endometriosic lesions, diminishing the postoperative symptomatology and avoiding any early relapse of the disease [41,42].…”

“…Intestinal dysfunction in these patients is defined by the existence of constipation or diarrhea during several weeks after the surgery, due to a mechanical effect by rectal reduction as well as a neural disorder because of the denervation of the rectal plexus. This is the most frequent complication, being 15-20%, although it can reach 85% in some [5,40,45,49,56].…”