Skip to main content
Erschienen in: Surgical Endoscopy 9/2007

01.09.2007

Laparoscopic segmental colorectal resection for endometriosis: limits and complications

verfasst von: E. Darai, G. Ackerman, M. Bazot, R. Rouzier, G. Dubernard

Erschienen in: Surgical Endoscopy | Ausgabe 9/2007

Einloggen, um Zugang zu erhalten

Abstract

Background

Deep pelvic endometriosis with colorectal involvement is a complex disorder often requiring segmental bowel resection. This study investigated the limits and complications of laparoscopic segmental colorectal resection.

Methods

Laparoscopic segmental colorectal resection was performed for 71 women with bowel endometriosis. Intra- and postoperative complications were evaluated, together with symptom outcomes, by means of questionnaires completed before and after surgery. Surgical procedures and complications were compared between the first part of the study (40 cases, previously published) and the second part (31 cases).

Results

Of the 71 women, 64 (90%) underwent laparoscopic segmental colorectal resection, with 7 requiring laparoconversion. Major complications occurred in nine cases (12.6%), six with rectovaginal fistulae and three with pelvic abscesses. The mean operating time decreased significantly during the study (p < 0.05). The mean follow-up period after colorectal resection was 24.4 ± 2.2 months. No differences in the rates of laparoconversion or complications were observed between the two periods, whereas major associated surgical procedures were more frequent during the second period. Dysmenorrhea (p < 0.0001), dyspareunia (p = 0.0001), pain at defecation (p = 0.0004), bowel movement pain or cramping (p < 0.0001), lower back pain (p < 0.0001), and asthenia (p < 0.0001) were improved after the operation, with no difference between the study periods.

Conclusion

This large series confirms the feasibility and efficacy of laparoscopic segmental colorectal resection. However, women must be informed of the risk for potentially severe complications.
Literatur
1.
Zurück zum Zitat Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55: 759–765PubMed Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55: 759–765PubMed
2.
Zurück zum Zitat Redwine DB (1992) Laparoscopic en bloc resection for treatment of the obliterated cul-de-sac in endometriosis. J Reprod Med 37: 695–698PubMed Redwine DB (1992) Laparoscopic en bloc resection for treatment of the obliterated cul-de-sac in endometriosis. J Reprod Med 37: 695–698PubMed
3.
Zurück zum Zitat Donnez J, Nisolle M (1995) Advanced laparoscopic surgery for the removal of rectovaginal septum endometriotic or adenomyotic nodules. Baillieres Clin Obstet Gynaecol 9: 769–774PubMedCrossRef Donnez J, Nisolle M (1995) Advanced laparoscopic surgery for the removal of rectovaginal septum endometriotic or adenomyotic nodules. Baillieres Clin Obstet Gynaecol 9: 769–774PubMedCrossRef
4.
Zurück zum Zitat Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Breart G (2003) Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod 18: 760–766PubMedCrossRef Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Breart G (2003) Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod 18: 760–766PubMedCrossRef
5.
Zurück zum Zitat Macafee CH, Greer HL (1960) Intestinal endometriosis: a report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Emp 67: 539–555PubMed Macafee CH, Greer HL (1960) Intestinal endometriosis: a report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Emp 67: 539–555PubMed
6.
Zurück zum Zitat Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69: 727–730PubMed Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69: 727–730PubMed
7.
Zurück zum Zitat Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232: 379–389PubMedCrossRef Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232: 379–389PubMedCrossRef
8.
Zurück zum Zitat Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdes CT (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53: 411–416PubMed Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdes CT (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53: 411–416PubMed
9.
Zurück zum Zitat Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37: 747–753PubMedCrossRef Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37: 747–753PubMedCrossRef
10.
Zurück zum Zitat Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1: 217–220PubMed Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1: 217–220PubMed
11.
Zurück zum Zitat Nezhat C, Nezhat F, Pennington E (1992) Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser. Br J Obstet Gynaecol 99: 664–667PubMed Nezhat C, Nezhat F, Pennington E (1992) Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser. Br J Obstet Gynaecol 99: 664–667PubMed
12.
Zurück zum Zitat Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13: 1125–1128PubMedCrossRef Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13: 1125–1128PubMedCrossRef
13.
Zurück zum Zitat Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96: 304–307PubMedCrossRef Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96: 304–307PubMedCrossRef
14.
Zurück zum Zitat Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 195: 754–758PubMedCrossRef Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 195: 754–758PubMedCrossRef
15.
Zurück zum Zitat Daraï E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192: 394–400PubMedCrossRef Daraï E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192: 394–400PubMedCrossRef
16.
Zurück zum Zitat Adamson GD, Nelson HP (1997) Surgical treatment of endometriosis. Obstet Gynecol Clin North Am 24: 375–409PubMedCrossRef Adamson GD, Nelson HP (1997) Surgical treatment of endometriosis. Obstet Gynecol Clin North Am 24: 375–409PubMedCrossRef
17.
Zurück zum Zitat Urbach DR, Reedijk M, Richard CS, Lie KI, Ross TM (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum 41: 1158–1164PubMedCrossRef Urbach DR, Reedijk M, Richard CS, Lie KI, Ross TM (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum 41: 1158–1164PubMedCrossRef
18.
Zurück zum Zitat Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full-thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20: 2317–2320PubMedCrossRef Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full-thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20: 2317–2320PubMedCrossRef
19.
Zurück zum Zitat Bergamaschi R, Yavuz Y, Marvik R (2003) Laparoscopic bowel resection: a comparison of three ultrasonically activated devices. JSLS 7: 19–22PubMed Bergamaschi R, Yavuz Y, Marvik R (2003) Laparoscopic bowel resection: a comparison of three ultrasonically activated devices. JSLS 7: 19–22PubMed
20.
Zurück zum Zitat Bergamaschi R, Marvik R (2001) Laparoscopic intracorporeal bowel resection with ultrasound versus electrosurgical dissection. JSLS 5: 17–20PubMed Bergamaschi R, Marvik R (2001) Laparoscopic intracorporeal bowel resection with ultrasound versus electrosurgical dissection. JSLS 5: 17–20PubMed
21.
Zurück zum Zitat Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O (1998) Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg 133: 309–314 Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O (1998) Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg 133: 309–314
22.
Zurück zum Zitat Merad F, Hay JM, Fingerhut A, Yahchouchi E, Laborde Y, Pelissier E, Msika S, Flamant Y (1999) Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery 125: 529–535 Merad F, Hay JM, Fingerhut A, Yahchouchi E, Laborde Y, Pelissier E, Msika S, Flamant Y (1999) Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery 125: 529–535
23.
Zurück zum Zitat Campagnacci R, Perretta S, Guerrieri M, Paganini AM, De Sanctis A, Ciavattini A, Lazoche E (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19: 662–664PubMedCrossRef Campagnacci R, Perretta S, Guerrieri M, Paganini AM, De Sanctis A, Ciavattini A, Lazoche E (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19: 662–664PubMedCrossRef
24.
Zurück zum Zitat McArdle CS, Morran CG, Pettit L, Gemmell CG, Sleigh JD, Tillotson GS (1995) Value of oral antibiotic prophylaxis in colorectal surgery. Br J Surg 82: 1046–1048PubMedCrossRef McArdle CS, Morran CG, Pettit L, Gemmell CG, Sleigh JD, Tillotson GS (1995) Value of oral antibiotic prophylaxis in colorectal surgery. Br J Surg 82: 1046–1048PubMedCrossRef
25.
Zurück zum Zitat Tran KT, Kuijpers HC, Willemsen WN, Bulten H (1996) Surgical treatment of symptomatic rectosigmoid endometriosis. Eur J Surg 162: 139–141PubMed Tran KT, Kuijpers HC, Willemsen WN, Bulten H (1996) Surgical treatment of symptomatic rectosigmoid endometriosis. Eur J Surg 162: 139–141PubMed
26.
Zurück zum Zitat Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76: 358–365PubMedCrossRef Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76: 358–365PubMedCrossRef
27.
Zurück zum Zitat Angioni S, Peiretti M, Zirone M, Palomba M, Mais V, Gomel V, Melis GB (2006) Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up. Hum Reprod 21: 1629–1634PubMedCrossRef Angioni S, Peiretti M, Zirone M, Palomba M, Mais V, Gomel V, Melis GB (2006) Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up. Hum Reprod 21: 1629–1634PubMedCrossRef
28.
Zurück zum Zitat Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21: 1243–1247PubMedCrossRef Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21: 1243–1247PubMedCrossRef
29.
Zurück zum Zitat Anaf V, Simon P, El Nakadi I, Simonart T, Noel J, Buxant F (2001) Impact of surgical resection of rectovaginal pouch of Douglas endometriotic nodules on pelvic pain and some elements of patients’ sex life. J Am Assoc Gynecol Laparosc 8: 55–60PubMedCrossRef Anaf V, Simon P, El Nakadi I, Simonart T, Noel J, Buxant F (2001) Impact of surgical resection of rectovaginal pouch of Douglas endometriotic nodules on pelvic pain and some elements of patients’ sex life. J Am Assoc Gynecol Laparosc 8: 55–60PubMedCrossRef
30.
Zurück zum Zitat Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F (2004) Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 190: 1020–1024PubMedCrossRef Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F (2004) Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 190: 1020–1024PubMedCrossRef
31.
Zurück zum Zitat Fedele L, Bianchi S, Zanconato G, Berlanda N, Borruto F, Frontino G (2005) Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol 193: 114–117PubMedCrossRef Fedele L, Bianchi S, Zanconato G, Berlanda N, Borruto F, Frontino G (2005) Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol 193: 114–117PubMedCrossRef
Metadaten
Titel
Laparoscopic segmental colorectal resection for endometriosis: limits and complications
verfasst von
E. Darai
G. Ackerman
M. Bazot
R. Rouzier
G. Dubernard
Publikationsdatum
01.09.2007
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 9/2007
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9160-1

Weitere Artikel der Ausgabe 9/2007

Surgical Endoscopy 9/2007 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.