Laparoscopic Resection of Small Bowel for Endometriosis: A Retrospective Analysis of Demographics, Clinical Presentation, Prevalence, Procedure and Short and Long Term Follow Up

Abstract

Study Objective: 1) To assess the correlation between the diagnosis by clinical presentation, laparoscopic observation and histopathological findings. 2) To assess efficacy and safety of laparoscopic small bowel resection in short and long term. Design: Retrospective study. Duration of follow up - 1 month to 96 months. Setting: Center for Endometriosis Care, a tertiary referral center for endometriosis, Atlanta, GA. Patients: Fourteen consecutive patients with small bowel endometriosis from year 2003 to 2010. Intervention: 1)Laparoscopic small bowel resection and reanastomosis. 2)Short and long term follow up with a standard questionnaire. Measurements and Main Results: At this referral center we have 144 cases of gastrointestinal endometriosis from year 2003 to 2010 and 14 small bowel endometriosis cases. Assessment included standard pre and post operative questionnaire for subjective symptoms and severity. Objective measurements were obtained by standard laparoscopic exploration of pelvis and abdomen. The disease was confirmed by histopathology report. Majority of patients were Caucasian in our study and age ranged from 25 to 49 years with an average of 35.1 years. Preoperative bowel symptoms included intestinal cramping in 85.7%, painful bowel movement in 78.5%, and constipation in 64.2% of patients. Major postoperative complication was seen only in one patient (7.1%). We found 93% positive correlation between the laparoscopic diagnosis and histopathological findings. Preliminary long term results show 100% symptom relief which is very promising. Conclusion: In our study small bowel endometriosis accounts for 9.7% of gastrointestinal endometriosis so we recommend laparoscopic exploration and management of small bowel in addition to large bowel in patients with bowel symptoms. In literature most small bowel endometriosis cases are diagnosed after emergent surgery for bowel obstruction. In order to avoid associated morbidity and mortality, we strongly advise resection of small bowel as plan of treatment after the diagnosis is made. Our data suggest that laparoscopic small bowel resection is a safe and effective procedure in hands of experienced team of laparoscopic gynecologist and surgeons.