Laparoscopic Resection of Large Abdominal Wall Endometriosis

Abstract

<h3>Study Objective</h3> To demonstrate surgical techniques for resection of large fascial and rectus muscle endometriosis implants. <h3>Design</h3> N/A. <h3>Setting</h3> The patient underwent surgery at a tertiary care center. She was placed in dorsal lithotomy position in steep Trendelenburg. Insufflation was carried out to 15 mmHg. A primary 10mm subxiphoid port was used for the camera and three additional 5mm assist ports were placed. <h3>Patients or Participants</h3> The patient is a 44-yo G1P1 with a history of a cesarean delivery, laparoscopic excision of endometriosis, and subsequent hysterectomy who presented with cyclic abdominal wall pain consistent with abdominal wall endometriosis diagnosed on MRI. <h3>Interventions</h3> Laparoscopic excision of abdominal endometriosis lesion with placement of polypropylene mesh. <h3>Measurements and Main Results</h3> Large sub-fascial abdominal wall endometriosis lesion was completely excised and resultant fascial defect successful closed with synthetic mesh. Patient was discharged same day, recovered without issue, and notes complete resolution of pre-operative symptoms. <h3>Conclusion</h3> Abdominal wall endometriosis involving the fascia or underlying structures can be safely and effectively resected using the laparoscopic techniques outlined in this video. This minimally invasive approach allows excellent operative exposure and a quicker recovery. In cases with large fascial defects, synthetic mesh should be utilized, and several techniques can be employed to reduce the incidence of post-op adhesions.