title: Laparoscopic treatment of deep infiltrating endometriosis: results of the combined laparoscopic gynecologic and colorectal surgery.
abstract: BACKGROUND
  The short-term results of a retrospective consecutive series of multidisciplinary laparoscopic approach to deep infiltrating endometriosis with intestinal involvement requiring segmental bowel resection procedures are presented.
  
  
  METHODS
  Patients with radiologically or intraoperative-confirmed endometriosis, who underwent a combined laparoscopic segmental bowel resection by a team of gynecologists and colorectal surgeons, were retrospectively reviewed. The postoperative data were collected in a specific database and analyzed for short-term (30 days) postoperative outcomes with the comparison between two specimen's extraction methods.
  
  
  RESULTS
  Forty-one patients (median age of 36 years, range 25-44) have been operated by a combined team of gynecologist and colorectal surgeons. The median operative time was 247.5 min (range 155-375), and median estimated blood loss was 300 ml (range 100-1300). In 20 patients, the surgical specimens were extracted transvaginally, while in 21 cases, a sovrapubic transverse Pfannenstiel minilaparotomy was used. No intraoperative complications or conversion to laparotomy were reported. An acceptable cumulative rate of postoperative morbidity was observed (6/41, 15 %), without any postoperative deaths. Comparing the two subgroups of patients with different modalities of specimen retrieval, postoperative pain (assessed by visual analog scale) was significantly reduced in the transvaginal extraction group (median: 1 and range: 0-2 vs median: 3, 5 and range: 1-6; p = 0.002), without any statistically significant differences in terms of complications.
  
  
  CONCLUSIONS
  Laparoscopic bowel segmental resection combined with gynecologic surgery for deep infiltrating endometriosis with intestinal involvement is a valid treatment option with a low rate of postoperative complications. Transvaginal specimen extraction allows the same results of minilaparotomic incision, minimizing surgical trauma and warranting a clear benefit in terms of reduction of postoperative pain.
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy. sambucci.daniele@gmail.com.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sambucci
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Spampatti
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cassinotti
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: David
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.affiliation: Minimally Invasive Research Center, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy. luigi.boni@uninsubria.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D010348:Patient Care Team; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies
keywords: Colorectal resection; Deep infiltrating endometriosis; Laparoscopy; Transvaginal