title: Histopathology-based combined surgical approach to rectovaginal endometriosis.
abstract: OBJECTIVE
  To describe a new surgical approach to rectovaginal endometriosis. Rectovaginal endometriosis can be infiltrative or superficial involving the bowel. Only infiltrative disease should be treated by intestinal resection. However, infiltration of endometriosis cannot be confirmed by preoperative imaging techniques.
  
  
  METHODS
  A total of 48 women with infiltrative rectovaginal endometriosis were included in this prospective study. Surgery was performed using a newly developed technique. All bowel resections were indicated according to operative findings and not on the basis of preoperative imaging technique results.
  
  
  RESULTS
  The decision for rectosigmoidal resection was based on the results of the intraoperative dissection of the rectovaginal septum. Histologically, infiltration of the ventral bowel wall was confirmed in all cases.
  
  
  CONCLUSIONS
  This new surgical technique for the treatment of rectovaginal endometriosis allows precise diagnosis and treatment with low morbidity. A resection of the mesorectum is not necessary because the endometriotic nodules are always located on the antimesenteric surface of the bowel.
authors: Department of Gynecology, Charité Campus Mitte, Berlin, Germany. mandy.mangler@charite.de
authors: Mandy
authors: M
authors: Mangler
authors: Christoph
authors: C
authors: Loddenkemper
authors: Malgorzata
authors: M
authors: Lanowska
authors: Julia
authors: J
authors: Bartley
authors: Achim
authors: A
authors: Schneider
authors: Christhardt
authors: C
authors: Köhler
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000473:pathology / Q000601:surgery*; D055815:Young Adult