title: A new technique for laparoscopic anterior resection for rectal endometriosis.
abstract: BACKGROUND
  Anterior rectal resection is sometimes necessary to treat deeply infiltrating rectovaginal endometriosis. We describe a completely laparoscopic approach as a new way of excising rectal endometriosis that can be used without opening any part of the rectum. This avoids opening the abdomen or any risk of fecal spillage.
  
  
  METHODS
  The patient received preoperative oral bowel preparation. Ureteric stents (6 F) were inserted cystoscopically. The peritoneum in the ovarian fossae was opened lateral to any disease and the rectum reflected off the back of the cervix, leaving any endometriosis on the front of the rectum. The pelvic peritoneum was reflected medially, below the level of the ureters. The mesorectum was then dissected off a 6-cm length of rectum by using a Harmonic scalpel. A circular end-to-end anastomosis instrument was passed anally until the outline of the anvil was visible, inside the colon, above the diseased rectum. The anvil was detached and held by a soft grasper before the rectum was then divided above and below the disease using a laparoscopic stapling device. The tip of the anvil was pushed through the proximal end of the colon allowing reanastomosis of the rectal stump.
  
  
  CONCLUSIONS
  The patient was discharged after 5 days without complications.
authors.affiliation: Worthing & Southlands Hospitals Trust, Worthing, West Sussex, BN11 2DH, United Kingdom. jolyon.ford@virgin.net
authors.forename: Jolyon
authors.initials: J
authors.lastname: Ford
authors.forename: James
authors.initials: J
authors.lastname: English
authors.forename: W F Anthony
authors.initials: WF
authors.lastname: Miles
authors.forename: Theo
authors.initials: T
authors.lastname: Giannopoulos
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D012002:Rectal Diseases / Q000601:surgery*