title: Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis.
abstract: OBJECTIVE
  To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR).
  
  
  METHODS
  This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital.  Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared.
  
  
  RESULTS
  Twenty-two patients underwent laparoscopic ADR (n 8) or LAR (n 14) for rectosigmoid endometriosis between January 2001 and December 2009. Mean follow-up time was 41.26 months (range, 14 to 70). Patients undergoing laparoscopic ADR had significantly less blood loss and shorter operative time  and hospital stay. Patients who required LAR had a significantly higher rate of mucosal involvement (61.5% v. 0%). No statistically significant difference was found in the size, depth of invasion, location of lesions, or operative complications. Fifty percent of the LAR group had several lesions  as opposed to 12.5% of the ADR group. Median age was significantly higher in patients who required LAR (39) than in patients who required ADR (32). Three patients in the LAR group (21.4%) had anastomotic strictures; 2 required dilation. The ADR group had consistently higher increments of improvement  in bowel symptoms and dyspareunia. Overall satisfaction rate with the procedures was 93.3%. SF-12 scores were comparable between the 2 groups.
  
  
  CONCLUSIONS
  ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic  strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.
authors: Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA. nmoawad@ufl.edu
authors: Nash S
authors: NS
authors: Moawad
authors: Richard
authors: R
authors: Guido
authors: Ramesh
authors: R
authors: Ramanathan
authors: Suketu
authors: S
authors: Mansuria
authors: Ted
authors: T
authors: Lee
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome