7693 Deep Infiltrating Endometriosis: Laparoscopic Treatment with Discal Resection

Abstract

<h3>Study Objective</h3> To show how deep intestinal endometriosis can be managed safely and effectively with laparoscopic discoid resection. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> The surgical management of deep endometriosis infiltrating the rectum employs either colorectal segmental resection or conservative techniques, i.e., shaving and discoid resection. When the nodule measures less than 3 cm in diameter, the discoid resection is applicable as an alternative to segmental colorectal resection. For surgery, the patient was placed in a dorsal modified lithotomy position. The surgeon was on the patient's left side, the first assistant on the right, and the second assistant between the patient's legs. <h3>Patients or Participants</h3> A 32-year-old patient presented to our center with dysmenorrhea, dyspareunia, dyschezia and chronic pelvic pain. On physical examination, in the pouch of Douglas, a painful nodule of approximately 2 cm was palpable, involving the left uterosacral ligament. In the MRI, it can be observed in the sagittal section T2 a hypointense nodule that obliterates the pouch of Douglas and involves the anterior wall of the rectum. The nodule contacts with the anterior wall of the rectum with a 27 mm expansion and a 9 mm maximal invasion. The distance between the nodule and the anal margin is 8 cm. <h3>Interventions</h3> Laparoscopic approach with discal resection to treat deep infiltrating endometriosis. Step-by-step demonstration of the surgery with the key points through a narrated video. <h3>Measurements and Main Results</h3> Patient evolves favorably in post operative care. Hospital discharge is given 48hs after the intervention. At 6-month follow-up, the patient reported resolution of all initial symptoms. <h3>Conclusion</h3> Discoid resection is an effective and safe alternative for trained surgeons with the aim of better preserving rectal function and reducing the risk of low anterior rectal resection syndrome that can be generated with bowel resection.