Instruments and methodsLaparoscopically assisted vaginal resection of rectovaginal endometriosis
Section snippets
Technique
After clinical examination under anesthesia, the posterior fornix of the vagina is exposed by two Breisky specula and the cervix is pulled ventrally by two tenacula. After infiltration of the vagina with 10 mL lidocaine hydrochloride 2% with epinephrine, an incision is made around the endometriotic nodule and the posterior cervix is dissected (Figure 1). To avoid bowel injury, the pouch of Douglas is not opened transvaginally. The vaginal resection margins must be free from endometriosis on
Experience
Thirty-four consecutive patients were operated on between December 1997 and July 1999 for endometriosis of the rectovaginal septum with large (over 2 cm in diameter) infiltration of the lower rectum (not more than 7 cm above the anus). Women were referred to our institution for radical surgery (including bowel surgery) because previous surgical and medical treatments had failed. Thirty-three had deep and extensive rectal infiltration with fixed mucosa confirmed by rectal examination. In 33
Comment
Deep endometriosis of the rectovaginal septum is a serious problem for women and physicians. Diagnosis can be established by routine vaginal examination because deep endometriosis is localized in the vagina, the pouch of Douglas, the uterosacral ligaments, or the rectovaginal space. The rectosigmoid has to be palpated to determine the extent of endometriotic infiltration. Catamenial rectal bleeding or pre- or intraoperative rectosigmoidoscopy are of limited value for judging extension of bowel
References (8)
- et al.
Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis
Fertil Steril
(1996) - et al.
Surgical treatment of deeply infiltrating endometriosis
- et al.
Rectovaginal septum, endometriosis or adenomyosisLaparoscopic management in a series of 231 patients
Hum Reprod
(1995) - et al.
A retrospective study of colostomies, leaks and strictures after colorectal anastomosis
Int J Colorectal Dis
(1990)
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