Laparoscopic Management of Bowel Endometriosis: Stanford Experience

Abstract

To describe the clinical characteristics of women with bowel endometriosis and our principles in laparoscopic management of this pathology. To identify predictors of severe disease and recurrence. Endometriosis is defined as the presence of endometrial-like tissue outside of the uterine cavity. Superficial or deep endometriosis can involve virtually any pelvic or extra-pelvic organ. The most common site of extragenital endometriosis is the intestinal tract; 80% of all extragenital endometriosis affects the bowel. The extent of intestinal wall resection necessary to adequately treat the disease is highly debated. The identification of high-stage and recurrent cases is critical, as these cases require careful surgical planning. Retrospective chart review. Tertiary referral center. 193 patients with pathologically confirmed bowel endometriosis. Laparoscopic treatment of bowel endometriosis. Predictors of higher stage endometriosis include a history of previous laparoscopic surgery (P = 0.04) and a presenting complaint of abnormal uterine bleeding (P = 0.01). The higher the stage of endometriosis, the more likely there would be coexistent urinary tract endometriosis (P = 0.02), a need for enterolysis (P = 0.002), ovarian cystectomy (P<0.001), and bowel resection (P = 0.01) performed during laparoscopy. Obesity was associated with higher rate of recurrence of endometriosis (P = 0.002). Within our cohort, 87% of our patients achieved amelioration of symptoms by the end of the first postoperative month. Disc excision and segmental bowel resection were performed on 73% and 1.6% of patients, respectively. Our study confirms that laparoscopic management of bowel endometriosis is safe and effective. Disc excision, as opposed to segmental bowel resection appears equally effective, safer and advisable in all but the most severe cases. We found two statistically significant predictors of higher stage disease that should prompt careful surgical planning.