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

Aim:

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.

Method:

All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the bowel were identified and reviewed from a prospective database.

Results:

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.

Conclusions:

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.