title: Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting.
abstract: BACKGROUND
  Endometriosis as a benign disease appears frequently in premenopausal women with highly variable symptoms. In advanced stages bowel involvement is common. In symptomatic disease the adequate treatment requires complete resection of all residues. Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The purpose of this study was to show the feasibility of planned complete laparoscopic management of symptomatic deep pelvic endometriosis with bowel involvement performing segmental colorectal resection in a center of excellence.
  
  
  METHODS
  Between 2007 and 2012 all patients treated for symptomatic colorectal endometriosis in our institution were included and retrospectively evaluated. Laparoscopic excision of all visible disease was planned. Data analysis included age, previous history of endometriosis, intraoperative findings, operative procedure and intra- and postoperative complications.
  
  
  RESULTS
  In this time period 35 patients with bowel infiltrating endometriosis were treated. Affected locations were the rectovaginal space in 31 patients (89 %), the rectum in 32 patients (91 %), the sigmoid colon in 10 patients (29 %), the coecum in 2 patients (5.7 %), the appendix in 3 patients (8.6 %) and the terminal ileum in 1 patient (2.9 %). In the majority of patients (85.7 %) the resection was achieved laparoscopically, in 3 patients a conversion to laparotomy was necessary and in 2 patients a primary laparotomia was performed. Complications occurred in 2 cases with anastomotic leakage in 1 patient (2.8 %) and a rectovaginal fistula in another patient. Radical resection was achieved in almost all patients (97 %).
  
  
  CONCLUSIONS
  A well-trained interdisciplinary team can perform treatment of deep infiltrating endometriosis laparoscopically with low incidence of major complications as anastomotic leakage or rectovaginal fistula. Criteria of complete endometriosis restoration of the rectum can be achieved by total or subtotal rectal excision.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany, robert.bachmann@med.uni-tuebingen.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Bachmann
authors.forename: Cornelia
authors.initials: C
authors.lastname: Bachmann
authors.forename: Jessica
authors.initials: J
authors.lastname: Lange
authors.forename: Bernhard
authors.initials: B
authors.lastname: Krämer
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.forename: Marty
authors.initials: M
authors.lastname: Zdichavsky
mesh_terms: D000328:Adult; D003082:Colectomy; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome