Rectal Shaving in Stage IV Endometriosis

Abstract

Study Objective To describe rectal shaving as a surgical approach to perform resection of deep infiltrating endometriosis of the bowel and to highlight available evidence for surgical management of colorectal deep infiltrative endometriosis. Design Video presentation. Setting University tertiary care hospital. Patients or Participants 42-yo nulliparous patient with abnormal uterine bleeding, leiomyomas, pelvic pain, 3 cm rectovaginal nodule, and a 12 cm endometrioma who underwent an uncomplicated total laparoscopic hysterectomy, right salpingo-oophorectomy, left salpingectomy, rectal shaving, endometriosis resection, enterolysis, and cystoscopy for Stage IV endometriosis. Interventions Studies have shown that laparoscopic surgery can improve pain in the context of deep infiltrating endometriosis. A complete resection of deep infiltrative endometriosis with definitive hysterectomy and salpingo-oophorectomy was undertaken with rectal shaving as a technique to address the colorectal endometriosis. Measurements and Main Results At the 6-week postoperative follow up, the patient reported resolution of pain symptoms. Conclusion In conclusion given its low bowel complication rate of 1 % and acceptable recurrence rate we perform conservative bowel shaving technique whenever possible. To describe rectal shaving as a surgical approach to perform resection of deep infiltrating endometriosis of the bowel and to highlight available evidence for surgical management of colorectal deep infiltrative endometriosis. Video presentation. University tertiary care hospital. 42-yo nulliparous patient with abnormal uterine bleeding, leiomyomas, pelvic pain, 3 cm rectovaginal nodule, and a 12 cm endometrioma who underwent an uncomplicated total laparoscopic hysterectomy, right salpingo-oophorectomy, left salpingectomy, rectal shaving, endometriosis resection, enterolysis, and cystoscopy for Stage IV endometriosis. Studies have shown that laparoscopic surgery can improve pain in the context of deep infiltrating endometriosis. A complete resection of deep infiltrative endometriosis with definitive hysterectomy and salpingo-oophorectomy was undertaken with rectal shaving as a technique to address the colorectal endometriosis. At the 6-week postoperative follow up, the patient reported resolution of pain symptoms. In conclusion given its low bowel complication rate of 1 % and acceptable recurrence rate we perform conservative bowel shaving technique whenever possible.