Urological and colorectal complications following surgery for rectovaginal endometriosis

Abstract

Objectives To report the short-and medium-term complications of laparoscopic laser excisional surgery for rectovaginal endometriosis.Design Retrospective cohort study.Setting University teaching hospital, UK. Methods Women were identified from operative database, and a case note review was performed. Data for surgical outcome and surgical complications were collected.Main outcome measures Rates of urinary tract and colorectal complications.Results A total of 128 women underwent surgery. Of these, 32 required intraoperative closure of a rectal wall defect, including 3 segmental rectosigmoid resections. There were three rectovaginal fistulae and one ureterovaginal fistula. Ureteric damage occurred in two women, and five women suffered postoperative urinary retention. The risk of intraoperative bowel intervention was increased in women who complained of cyclical rectal bleeding.Conclusion Laparoscopic laser excision of rectovaginal endometriosis is a safe procedure with similar, if not lower, complication rates to other published surgical series.

Laparoscopic management of ureteral lesions in gynecology

“…An overall 1.5% of ureteral lesions in deep endometriosis surgery without hydronephrosis is similar to the overall reported incidences of ureteral lesions between 0.5 and 4% (1)(2)(3)(4)12). As can be expected, but to the best of our knowledge not yet reported, the incidence increases when hydroureteronephrosis is present.…”

Comparison between standard and reverse laparoscopic techniques for rectovaginal endometriosis

“…In a series of 136 patients presenting posterior deep endometriotic lesions, Koninckx and Martin [14] were able to identify only 16.7% of true rectovaginal septum nodules. [1][2][3][4][5][15][16][17][18][19][20][21]. The latter can be performed by laparotomy, laparoscopy, or laparoscopically assisted vaginal approach.…”

“…Nevertheless, surgery for rectovaginal endometriosis can be complex and challenging and often involves a multidisciplinary team (gynecologists, colorectal surgeons, and urologists) [4]. The procedure requires dissection of the pararectal space, ureterolysis (when the lesion extends to the pelvic sidewall), vaginal wall resection, and rectal dissection (associated or not to rectal surgery) [19].…”

“…The surgical procedure can be very complex because there is a high risk of bowel and urinary tract involvement in this form of disease [4]. Ureterolysis often is necessary and in cases of bowel involvement, surgical excision of the lesion must be performed.…”

Endometriosis does not Increase Risk of Surgical Complications. A Comparative Study

“…Repeated surgery is common [3], often alternated with hormonal treatment. Previous investigations concerning the results of surgery have focused on certain manifestations such as ovarian, peritoneal or deep infiltrating endometriosis, laparoscopic operations or results obtained by a single surgeon [4][5][6][7].…”