Laparoscopic Resection of Bowel Endometriosis
A Shukla-Kulkarni, Keith Johnston, Michael Cooper, Geoff Reid
Sydney Women’s Endosurgery Centre,
St George Hospital, Kogarah,NSW, Sydney Australia
Surgical treatment of patients with rectal endometriosis is challenging. The aim of this study was to review the laparoscopic management of rectal endometriosis by resection.
All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the bowel were identified and reviewed from a
135 patients between January2000 and May 2006 had surgical procedures performed for severe rectal endometriosis. This was a multi disciplinary approach involving two senior gynecologic laparoscopic surgeons and colorectal surgeons.Rectal procedures were primarily laparoscopic,with 10% conversion rate to laparotomy.15% had shaving of rectal wall lesion, 45% had disc resection of anterior rectal wall using the ELS system, 35% had laparoscopic assisted segmental low anterior resection.5% of patients had other sites of endometriosis on bowel which were managed laparoscopically by excision. There was one rectal anastomotic leak.
Patients with complex endometriosis of the bowel can be safely managed laparoscopically using a multidisciplinary approach.This case.series suggests that a history of rectal pain during defecation that occurs only during menstruation
is predictive of females with more extensive rectal disease.