General Obstetrics and Gynecology: Gynecology
Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis

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Objective

This study was undertaken to evaluate the feasibility and complications of laparoscopic segmental colorectal resection for endometriosis and its efficacy on gynecologic and digestive symptoms.

Study design

After magnetic resonance imaging and rectal endoscopic sonographic evaluation of symptomatic colorectal endometriosis, 40 consecutive women requiring colorectal resection were included in this study. Symptom questionnaires were completed before and after the procedure. Perioperative complications and linear intensity scores for several gynecologic and digestive symptoms were recorded.

Results

Thirty-six women (90%) underwent laparoscopic segmental colorectal resection and 4 required laparoconversion. Major complications occurred in 4 cases (10%), including 3 rectovaginal fistulae and 1 pelvic abscess. Transient urinary dysfunction occurred in 7 women (17.5%). Median follow-up after colorectal resection was 15 months (3-22 months). Median overall preoperative and postoperative pain scores were 8 ± 1 (range 4-10) and 2 ± 2 (0-10), respectively (P < .0001). Nonmenstrual pelvic pain (P = .0001), dysmenorrhea (P < .0001), dyspareunia (P = .0001), and pain on defecation (P < .0005) were improved by colorectal resection. Lower back pain and asthenia were not improved.

Conclusion

Our results suggest that laparoscopic segmental colorectal resection for endometriosis is feasible but carries a risk of major postoperative complications. Colorectal resection improved gynecologic and digestive symptoms, and the overall pain score.

Section snippets

Patients

Between March 2001 and March 2003, 46 women with colorectal endometriosis were referred to the gynecology department of Tenon Hôspital, Paris, France. Before surgery, all women underwent both MRI and RES. To avoid a possible bias linked to the type of surgery, only women with a muscularis involvement detected by MRI and RES underwent a segmental colorectal resection and were included in this study; those with no muscularis involvement underwent superficial rectal resection (6 women) and were

Preoperative MRI and RES findings

MRI showed colorectal endometriosis in all 40 women (Figure 1, A and B). The median lesion size was 2.5 cm (range: 1-5.5 cm). Colorectal endometriosis was associated with endometriomas in 17 women (42.5%) (bilateral in 6 cases, left-sided in 7 cases, and right-sided in 4 cases), and with uterosacral ligament involvement in 33 women (82.5%). Rectovaginal septum involvement was found in 7 women (17.5%), and uterine adenomyosis in 7 women (17.5%). One woman had cervical involvement.

RES showed

Comment

This study demonstrates that laparoscopic segmental colorectal resection for endometriosis is feasible and significantly improves both gynecologic and digestive symptoms. Rectovaginal fistula was a significant complication, especially when partial vaginal resection was required.

The feasibility and safety of laparoscopic surgical techniques can be estimated on the basis of the laparoconversion rate and perioperative complications. In contrast to previous studies,16, 17, 18, 19 we only enrolled

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