The treatment of rectal endometriosis and the role of laparoscopic surgery

Abstract

Laparoscopic shaving or disc excisions for rectal endometriotic foci or rectal resections are feasible and efficient methods for treating rectal endometriosis. More complex surgery to the bowel means more risk for complications. With the rising learning curve of the operators, laparoscopic rectal resections have become a safe option that should be offered to patients. The patient's preference to a particular treatment option should be central to the type of surgery to be elected.

Laparoscopic Surgery for Colorectal Endometriosis and its Impact upon Fertility: An Updated Australian Series of 307 Cases

“…The feasibility of laparoscopic colorectal resection may crudely be measured by the need for conversion to laparotomy and the incidence of complications (3, 5). In the present study, the conversion rate was 7.5% (23 cases out of 307).…”

“…Conversion rates of between 0% and 20% exist for other studies performing similar surgery, although the sample sizes vary considerably between these studies (3, 5). The present conversion rate of 7.5% is acceptable, particularly given the severity of disease and complexity of the procedures.…”

“…Diagnosis is often difficult, as clinical manifestations vary considerably and are often non-specific. Features may include dysmenorrhoea, chronic pelvic pain, infertility, dyspareunia and adnexal masses, or relate more specifically to colorectal involvement such as constipation, rectal bleeding, tenesmus and dyschezia (5). There have been rare cases reported of colorectal endometriosis presenting with bowel obstruction (6, 7), colonic perforation (8) and intussusception (9).…”

Endometriosis: Survey of Current Diagnostic and Therapeutic Options and Latest Research Work

“…The therapy of choice for symptomatic DIE is resection with healthy margins [61][62][63][64]. The operations often include rectum resection (mostly en-bloc with the afflicted rectovaginal septum and the vagina), and partial resection of the sacrouterine ligament and parametria as well as parts of the bladder (see l " Figs.…”

Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years' experience from a tertiary referral unit

“…Up to 10% of women with endometriosis will have rectovaginal disease [1]. Evidence has been building over the past few years, that excision of rectal deeply infiltrating endometriosis (DIE) is associated with faster resolution of symptoms [2–5], but doubts have been expressed about resection-related complications [6–8]. The current literature reports limited information regarding bowel symptomatology following limited segmental anterior rectal resection (LSARR) for endometriosis.…”