title: A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. fabio.ghezzi@uninsubria.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciravolo
authors.forename: Fabio
authors.initials: F
authors.lastname: Rampinelli
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
mesh_terms: 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