Histopathology-based combined surgical approach to rectovaginal endometriosis.
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.
Mangler
Mandy
M
Department of Gynecology, Charité Campus Mitte, Berlin, Germany. mandy.mangler@charite.de
Loddenkemper
Christoph
C
Lanowska
Malgorzata
M
Bartley
Julia
J
Schneider
Achim
A
Köhler
Christhardt
C
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