Transvaginal ultrasound after bowel preparation to assist surgical planning for bowel endometriosis resection

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up 3 as those more than The rectosigmoid colon (RSC) is involved in up to 93% of all endometriotic lesions of the bowel [1]. Preoperative diagnosis of bowel endometriosis is very important for surgical planning and patient counseling. In this context, estimation of the distance from endometriotic lesions to the anal border hasmajor surgical implications because the risk of complications is greater for gastrointestinal anastomosis performed below the peritoneal reflection, in the lower rectum (less than 5 cm from the anal border) [2]. From the authors’ personal experience (MOCG and LPC), transvaginal ultrasound after bowel preparation (TVS-BP) improves the detection and characterization of intestinal lesions, permitting identification of the affected layers and the distance between the lower margin of the lesions and the anal border. Fifty-one patients who presented with endometriosis-associated infertility at the Huntington Medicina Reprodutiva Sao Paulo, Brazil, from October 2005 to October 2006 underwent TVS-BP measurement of the distance between RSC lesions to the anal border, and laparoscopic excision of endometriosis. Eighteen bowel lesions were resected in 16 women. During surgery, the actual distances between the endometriotic lesions and the anal border were recorded as the distance from the insertion of an endoscopic stapler at the anal border up to where the tip of the stapler touched the lesion. Lesions were divided into 3 groups based on their distance from the anal border, with group 1 categorized as those from1–5 cm (1/18; 5.6%); group 2 as those 6–10 cm (9/18; 50%); and gro