1772 A Novel Technique: Mesh Repair After Excision of Rectus Muscle Endometriosis

Abstract

Video Objective The purpose of this video is to demonstrate the laparoscopic excision of rectus muscle endometriosis and repair utilizing mesh. This video will review imaging that identifies rectus muscle endometriosis, demonstrate when mesh should be used, and describe techniques utilized to place mesh. This video also demonstrates the use of an omental flap to prevent the formation of adhesions. Setting Stepwise demonstration of techniques with narrated video footage and presentation of three case reports at a single academic medical center. Interventions The laparoscopic excision of rectus muscle endometriosis can be challenging due to the location and extent of disease. A pelvic MRI can be used if suspicion of rectus muscle endometriosis is present. When encountering rectus muscle endometriosis, the use of ultrasound-guided wire localization can help identify smaller, non-palpable lesions. A subxiphoid port and a 45-degree angled laparoscope can be used to achieve optimal visualization. Depending on the size of the defect, mesh may need to be placed to repair the fascia. This can be performed with absorbable tacks, but if the required mesh is large in size, it may require suture as well. Finally, an omental flap can be utilized as a barrier between bowel and the mesh to prevent the future formation of adhesions. Conclusion Rectus muscle endometriosis is a rare cause of pelvic pain, but when diagnosed, can be successfully treated with a laparoscopic excision. A pelvic MRI can aid with diagnosis and help with surgical planning. Treatment involves wide surgical excision and if the resulting fascial defect is large, mesh may be utilized to repair the defect. Consideration of an omental flap can also be used to prevent future adhesions.