title: Laparoscopic disk resection for bowel endometriosis using a circular stapler and a new endoscopic method to control postoperative bleeding from the stapler line.
abstract: BACKGROUND
  Complete laparoscopic excision of endometriosis offers good longterm symptomatic relief, especially for those with severe or debilitating symptoms. Intestinal endometriosis affect between 3% and 36% of women with endometriosis and 50% of women with disease severe enough that intestinal surgery, with or without intestinal segmental resection, may be required.
  
  
  METHODS
  Between January 2003 and September 2006, we performed 35 laparoscopic complete excisions of endometriosis with full thickness disk resections of bowel endometriosis using the CEEA stapler (US Surgical) inserted transanally.
  
  
  RESULTS
  The endometriotic nodule of the bowel was completely removed in all patients. No major or minor surgical complications occurred during the primary surgical procedure. One patient underwent a diverting temporary ileostomy because of air loss after insufflation of the rectosigmoid colon, which was closed successfully 1 month after surgery. In three of seven cases of rectal bleeding from the stapler line, for the first time, we successfully used conservative endoscopic management.
  
  
  CONCLUSIONS
  In properly selected patients, full thickness disk excision using a circular stapler is a feasible procedure that avoids the potential morbidities of a low anastomosis. We suggest conservative management by endoscopic hemostasis before referring patients for a new operation in cases of rectal bleeding from the anastomotic site.
authors.affiliation: Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar (Verona), Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Landi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pontrelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Surico
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruffo
authors.forename: Marco
authors.initials: M
authors.lastname: Benini
authors.forename: David
authors.initials: D
authors.lastname: Soriano
authors.forename: Liliana
authors.initials: L
authors.lastname: Mereu
authors.forename: Luca
authors.initials: L
authors.lastname: Minelli
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012002:Rectal Diseases / Q000601:surgery*; D012086:Reoperation; D012812:Sigmoidoscopy; D013528:Surgical Staplers