title: Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis.
abstract: BACKGROUND
  Multidisciplinary laparoscopic treatment is the standard of care for radical treatment of deep infiltrating pelvic endometriosis. If bowel resection is necessary, a muscle-split or Pfannenstiel incision is also required. The avoidance of any laparotomy could decrease surgical stress response, give a faster return to normal bowel function, decrease post-operative pain and reduce wound complications and incisional hernias. We assessed post-operative outcome after a full laparoscopic sigmoid resection for bowel endometriosis.
  
  
  METHODS
  Twenty-one patients who underwent elective full laparoscopic sigmoid resection for bowel endometriosis from September 2009 to September 2010 were matched for age, American Society of Anesthesiologists class and BMI to 21 patients who underwent a conventional laparoscopic sigmoid resection. Groups were compared for peri-operative factors, complications, length of hospital stay, post-operative pain (Visual Analog Scale: VAS), analgesics consumption and inflammatory response (plasma C-reactive protein: CRP).
  
  
  RESULTS
  Median operating time was 15 min shorter with transrectal specimen extraction (P = 0.003). VAS-scores and use of analgesics were higher in the conventional laparoscopic group (P = 0.0005). Mean CRP-level tended to be higher in the transrectal specimen extraction group (38%, P = 0.054) but there was no difference in increase in CRP level between groups (P = 0.15). There were no anastomotic leaks or reinterventions in either group, and the median hospital stay was similar. At follow-up, no wound infections or incisional hernias were observed and no patients reported anal dysfunction.
  
  
  CONCLUSIONS
  Full laparoscopic sigmoid resection reduced operating times and decreased post-operative VAS-scores and analgesic requirements compared with the conventional laparoscopic sigmoid resection for bowel endometriosis.
authors.affiliation: Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. albert.wolthuis@uzleuven.be
authors.forename: A M
authors.initials: AM
authors.lastname: Wolthuis
authors.forename: C
authors.initials: C
authors.lastname: Meuleman
authors.forename: C
authors.initials: C
authors.lastname: Tomassetti
authors.forename: T
authors.initials: T
authors.lastname: D'Hooghe
authors.forename: S
authors.initials: S
authors.lastname: Fieuws
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D012809:Colon, Sigmoid / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000082:Acetaminophen; D002097:C-Reactive Protein