Laparoscopic resection of intestinal endometriosis: a 5-year experience.
OBJECTIVE
To describe the clinical manifestations, surgical techniques, and complications observed in patients undergoing laparoscopic resection of intestinal deeply infiltrating endometriosis (DIE).


METHODS
Prospective nonrandomized (Canadian Task Force Classification II-3).


METHODS
University hospital and private practice.


METHODS
We evaluated 125 patients with intestinal DIE treated from February 2000 through September 2005.


METHODS
Laparoscopic radical excision of DIE followed by resection of the rectosigmoid colon.


RESULTS
The clinical examination of our patients demonstrated that 66.4% of patients had tenderness, whereas 80.8% had nodules on the pouch of Douglas. In 95.2% we observed pain caused by cervical mobilization, and all the patients had pain during the pouch of Douglas mobilization. Regarding bowel infiltration, preoperative investigation with rectal endoscopic ultrasonography was positive in all cases. Endoscopic rectal ultrasonography demonstrated the depth of intestinal infiltration. Superficial lesions were observed in 9.6% of patients and muscularis involvement in 71.2%. The segmental resection was performed in most of the patients (92%) and the linear resection in 6.4% of them. Median surgical time was 110 minutes, and the median hospital stay was 7 days after the surgery; the patients continued fasting for 3 to 7 days. The return to normal activity was achieved in a median 15 days after the surgery. The surgical procedure and the postoperative follow-up demonstrated no complications in 90.4% of the patients. Minor complications were observed in 4% of the cases. Major complications occurred in 5.6% of the patients, including 2 cases of intestinal fistulas (1.6%) and 3 cases of long-lasting urinary retention (2.4%).


CONCLUSIONS
Clinical symptoms of patients with intestinal endometriosis are not specific. Operative laparoscopy is a safe and effective method to treat intestinal endometriosis. To avoid major complications, special attention must be paid to the intestinal anastomosis and to the nerve preservation.
Ribeiro
Paulo Augusto Ayroza
PA
OG/Gyn Department, Santa Casa Medical School, São Paulo, Brazil. payroza@uol.com.br
Rodrigues
Francisco C
FC
Kehdi
Ivani P A
IP
Rossini
Lucio
L
Abdalla
Helizabet S
HS
Donadio
Nilson
N
Aoki
Tsutomu
T
D000328:Adult; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D012809:Colon, Sigmoid; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome