Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: results of a systematic three-step vagino-laparoscopic approach.
OBJECTIVE
Recto-vaginal endometriosis remains a surgical challenge. We propose a systematic surgical approach combining vaginal and laparoscopic steps for patients affected by deep endometriosis infiltrating the vaginal wall.


METHODS
This is a prospective observational study, performed at Campus Bio-Medico of Rome, University Teaching Hospital. All consecutive patients, from 2008 to 2011, affected by symptomatic deep recto-vaginal endometriosis with full thickness vaginal wall involvement, underwent a systematic surgical approach, based on three consecutive surgical steps: vaginal route, laparoscopic approach and final vaginal excision. All patients included in the study were scheduled for two years' follow-up with pelvic examination, transvaginal ultrasound and visual analog scale (VAS) evaluation of symptoms (dysmenorrhea, dyspareunia and chronic pelvic pain) at 3, 6, 12 and 24 months.


RESULTS
Thirty-four patients were enrolled. No major complications were registered. Complications included superficial vascular lesions in two cases (5.9%), ureteral stenosis two weeks after surgery in one patient (2.9%), and bowel obstruction for paralytic ileus in one patient (2.9%). A de novo endometrioma was found at 12 months after surgery and a recurrent endometrioma was evident at 24 months. For all symptoms evaluated, there was a significant improvement within 3 months after surgery (p<0.05) and no statistically significant difference during follow-up (at 3, 6, 12 and 24 months).


CONCLUSIONS
The proposed systematic surgical approach consisting of three consecutive steps could simplify the approach to deep endometriosis while at the same time increasing the quality of endometriosis surgery, with important benefit for the women affected.
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Roberto
R
Angioli
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Carlo
C
De Cicco Nardone
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy. Electronic address: ester5.c@libero.it.
Ester Valentina
EV
Cafà
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Francesco
F
Plotti
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Ludovico
L
Muzii
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Roberto
R
Montera
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Federica
F
Guzzo
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Daniela
D
Luvero
University Campus Bio-Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy.
Corrado
C
Terranova
D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*
Endometriosis; Laparoscopy; Recto-vaginal