Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection

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].…”

Laparoscopic Excision of Endometrioma

“…For adolescents who present with dysmenorrhea, the recommended approach is to first prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives. 17,18 The lack of measurable pain relief with these drugs is usually an indication for further investigation. 19 Other indications for laparoscopy include severe pain over several months, pain requiring systemic therapy, pain resulting in days off work or school, or pain requiring admission to hospital.…”

“…16,26 Even with experienced laparoscopic surgeons, the cumulative rate of recurrence after five years is nearly 20%. 17 Another study reported recurrence of dysmenorrhea in almost a third of women within one year of laparoscopic surgery in women who received no other treatment. 16 …”

“…Although reported long-term outcomes are encouraging with advanced laparoscopic techniques, there are few prospective studies and no randomised controlled trials. 16,17 One small study of the levonorgestrel intrauterine system in women with rectovaginal endometriosis found improved dysmenorrhea, pelvic pain, and dyspareunia after one year.…”