A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis.
OBJECTIVE
To present our experience with a new technique for laparoscopic rectosigmoid resection in patients with endometriosis.


METHODS
Prospective collaborative cohort study.


METHODS
Gynecologic departments of two university hospitals.


METHODS
Thirty-three women with rectosigmoid endometriotic lesions requiring segmental bowel resection.


METHODS
Laparoscopic intracorporeal division of the distal bowel and exteriorization of the affected segment via a colpotomy incision to complete the resection.


METHODS
Intraoperative and postoperative complications, and relief from symptoms.


RESULTS
The only intraoperative complication was bleeding from the inferior mesenteric artery that required conversion to laparotomy to obtain hemostasis. No patient required a temporary colostomy. No anastomotic complications were identified. Postoperative complications included a symptomatic pelvic seroma that required operative drainage in 1 patient and urinary retention that required intermittent self-catheterization in 3 women. The median follow-up duration was 13 months (range, 3-27 mo). Twenty-seven women were symptom free at the time of last follow-up evaluation. No patient had recurrent cyclic rectal bleeding, rectal pain on defecation, or tenesmus. Postoperatively, 4 of 13 patients who tried to conceive were successful.


CONCLUSIONS
Segmental colorectal resection with a combined laparoscopic-transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis.
Ghezzi
Fabio
F
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. fabio.ghezzi@uninsubria.it
Cromi
Antonella
A
Ciravolo
Giuseppe
G
Rampinelli
Fabio
F
Braga
Marco
M
Boni
Luigi
L
D000328:Adult; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D020884:Colpotomy / Q000009:adverse effects; D004715:Endometriosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome