Laparoscopic management of colorectal endometriosis |
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Authors: | B L Jerby H Kessler T Falcone J W Milsom |
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Institution: | (1) Department of Colorectal Surgery and The Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA, US;(2) Department of Gynecology and The Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA, US |
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Abstract: | Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery.
The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center.
Methods: From November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively
evaluated. Those with colorectal involvement were analyzed for stage of disease, procedure, operative time, conversion rate,
length of hospitalization, and complications.
Results: In 30 of the 509 patients (5.9%), colorectal involvement was identified. Twenty-eight of these 30 had stage IV disease. Intestinal
involvement was suspected preoperatively in 13 of 30. Twelve required superficial excision of colon or rectal endometriomas.
Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patients. Four cases
required conversion due to the overall severity of the pelvic disease. For those who did (n= 12) and did not (n= 18) require full-thickness excisions/resections, the median operative time was 180 min (range, 90–390) and 110 min (range,
45–355), respectively; the median length of hospitalization was 4 days (range, 3–7) and 1 day (range, 0–4), respectively.
A major complication occurred in one patient (colovaginal fistula). At a median follow-up of 10 months (range 1–32), 28 patients
were improved, and 24 of these had near or total resolution of preoperative symptoms.
Conclusions: Extensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic
treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients.
Received: 1 April 1998/Accepted: 22 March 1999 |
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Keywords: | : Laparoscopic surgery — Endometriosis — Intestinal endometriosis — Bowel resection |
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