Surgical management of ovarian endometrioma: cystectomy by stripping of the capsule

Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis

“…It is likely that bowel resection and reanastomosis leaves behind less microscopic disease (Remorgida et al, 2005;Roman et al, 2009), possibly resulting in lower recurrence rates (Stepniewska et al, 2009;Meuleman et al, 2011) when compared with simple resection of a fibrotic bowel nodule because bowel endometriosis, rather than having the shape of a plaque, may follow the enteric nervous system (Anaf et al, 2004), may spread laterally to the point of serosal invasion (Remorgida et al, 2005) and has a multifocal and multicentric nature (Redwine and Wright, 2001;Kavallaris et al, 2003;Keckstein and Wiesinger, 2005;Remorgida et al, 2007). On the other hand, even where rectal segmental resection is performed, endometriotic foci may be found on and outside the limits of the digestive resection, as we (Meuleman et al, 2009) and others (Roman et al, 2009) have shown.…”

Deep rectovaginal endometriotic nodules: perioperative complications from a series of 3,298 patients operated on by the shaving technique

“…Indeed, rates of urinary retention (3-10 %), ureteral lesions (2-4 %), fecal peritonitis (3-5 %), severe anastomotic stenosis (3 %), rectovaginal fistulas (6-9 %), and pelvic abscesses (2-4 %) were found to be significantly higher than with the shaving technique. A possible bias could have been the relatively small number of patients involved in some series, but it should be pointed out that, even in very experienced hands [12,42], the rate of severe complications (rectovaginal fistulas, abscesses, stenosis, fecal peritonitis) can be more than 10 %.…”

“…The rate of recurrent pain observed in this large series was therefore no higher than that encountered after more aggressive surgery, including bowel resection. In the majority of series reporting data on bowel resection, the recurrence rate of severe pelvic pain is evaluated to be 6-20 % [6][7][8][9][10][11][12][13][14]42]. However, in these studies, it is difficult to gauge the proportion of women suffering from pelvic pain due to a genuine recurrence of endometriosis and those with postoperative adhesions related to severe complications, such as pelvic abscesses or peritonitis.…”

“…We conducted a review of complication rates encountered after bowel resection for deep nodular endometriosis [6][7][8][9][10][11][12][13][14][15]42] (Table 2.). Unfortunately, much of the recent literature appears to encourage very invasive techniques, including bowel resection in case of rectal muscularis involvement.…”

“…The first study reporting the shaving technique and data from a series of 231 cases of laparoscopic management of deep endometriosis was published in Human Reproduction in 1995 [3], followed by a second study (n0 500 patients) published in BJOG in 1997 [4] and a third one (n01,942 patients) published in 2004 [5]. But surprisingly, the number of manuscripts advocating bowel resection has dramatically increased over recent years [6][7][8][9][10][11][12][13][14][15]. Koninckx et al (see [16]) and Donnez et al [17], firm advocates of the shaving technique, are increasingly confounded by this rapidly growing prevalence of bowel resection in the case of deep endometriosis with rectal muscularis involvement.…”