title: Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum.
abstract: BACKGROUND
  Two surgical approaches are employed in the treatment of deep infiltrating endometriosis of the rectum (DIER): colorectal resection and nodule excision. In 2009, we introduced a new technique for transanal full thickness disc excision of endometriotic nodules infiltrating the low and middle rectum, using the Contour® Transtar™ stapler (Ethicon Endo-Surgery inc., Cincinnati, OH, USA). The aim of this retrospective study was to describe the technique and to present data on the feasibility of this technique.
  
  
  METHODS
  From April 2009 to October 2010, all patients presenting with DIER and undergoing full thickness excision using the Contour® Transtar™ stapler were enrolled in the study. Pre-, intra- and post-operative data were collected and reported.
  
  
  RESULTS
  Six nulliparous women were managed using this technique during the study period. The rectal wall discs removed measured from 40 × 45 to 60 × 50 mm. In two cases, microscopic foci were noted on one of the margins but in four cases the limits were clear. Operating time varied from 180 to 450 min. Four women were completely free of post-operative digestive complaints.
  
  
  CONCLUSIONS
  Despite the small numbers in this series, our data suggest that the new technique of transanal rectal disc excision using the contour stapler may be applied in patients with infiltrating endometrial nodules of the rectum up to 10 cm from the anal margin and up to 5 cm in diameter. This new procedure promises to be a useful addition to the surgeon's armamentarium in a multidisciplinary approach to deep pelvic endometriosis.
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.forename: Babak
authors.initials: B
authors.lastname: Kianifard
authors.forename: Maud
authors.initials: M
authors.lastname: Vassilieff
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
authors.forename: Francis
authors.initials: F
authors.lastname: Michot
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000517:prevention & control; D015331:Cohort Studies; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011351:Proctoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013528:Surgical Staplers; D011795:Surveys and Questionnaires