Laparoscopic disk resection for bowel endometriosis using a circular stapler and a new endoscopic method to control postoperative bleeding from the stapler line.
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.
Landi
Stefano
S
Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar (Verona), Italy.
Pontrelli
Giovanni
G
Surico
Daniela
D
Ruffo
Giacomo
G
Benini
Marco
M
Soriano
David
D
Mereu
Liliana
L
Minelli
Luca
L
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