8453 Low Anterior Resection in Stage IV Endometriosis in a Post Hysterectomy Patient

Abstract

<h3>Study Objective</h3> To demonstrate technique in resection of stage IV endometriosis in a post-hysterectomy patient, including parametrial dissection, ureterolysis, rectovaginal mobilization, and low anterior resection with reanastamosis. <h3>Design</h3> A narrated surgical video. <h3>Setting</h3> An endometriosis-focused surgical practice in the private setting. <h3>Patients or Participants</h3> The patient is a 40-year-old woman with three previous laparoscopies, including hysterectomy and bilateral salpingoopherectomy. She was notably told after her most recent laparoscopy that she had no residual disease. Patient presented for consult with severe dyschezia, dyspareunia, and pelvic pain. Exam findings were concerning for severe rectovaginal endometriosis at the pelvic cuff. <h3>Interventions</h3> The patient was taken to OR for diagnostic laparoscopy, and ultimately a full excision of endometriosis was performed, including parametrectomy, ureterolysis, and low anterior colon resection with stapled reanastamosis. <h3>Measurements and Main Results</h3> 6 months postop the patient reports near complete relief of her symptoms, and substantially improved quality of life. <h3>Conclusion</h3> Low anterior resection in stage IV endometriosis may be necessary even after hysterectomy for endometriosis. A previous negative laparoscopy does not rule out high grade disease, as inexperienced physicians may under diagnose even severe disease. Hysterectomy and salpingoopherectomy does not resolve pre-existing rectovaginal endometriosis, and symptoms may persist or even worsen despite this treatment.