Laparoscopic Segmental Bowel Resection Research Articles

Nerve-Sparing Laparoscopic Segmental Bowel Resection for Deep Endometriosis: The Negrar Method

<h3>Study Objective</h3> to demonstrate a nerve-sparing technique during laparoscopic segmental bowel resection for deep endometriosis. <h3>Design</h3> A step-by-step demonstration of surgical procedure of laparoscopic segmental bowel resection. <h3>Setting</h3> In several cases, segmental bowel resection may be necessary to achieve complete removal of the disease and significantly improve the quality of life. Laparoscopic complete excision of deep-infiltrating endometriosis can seriously affect bladder, rectal, and sexual function. The goal of the nerve-sparing approach is to better identify the visceral neural fibers and surgical landmarks. <h3>Patients or Participants</h3> patients who underwent nerve-sparing laparoscopic complete excision of endometriosis with segmental bowel resection (‘‘The Negrar Method''). <h3>Interventions</h3> Our surgical nerve-sparing bowel resection technique proceeds in 5 steps: Step 1 Development of the medial pararectal space (Okabayashi's space) and development of the lateral pararectal space (Latzko's space) and isolation of the ureteral course Step 2 Opening of the presacral space, development of avascular spaces, and identification and preservation of pelvic sympathetic fibers of the inferior mesenteric plexus, superior hypogastric plexus, upper hypogastric nerves. Step 3 Development of the rectovaginal space Step 4 The previously skeletonized inferior mesenteric vessels are transected Step 5 Rectal resection and colorectal anastomosis <h3>Measurements and Main Results</h3> The Nerve-sparing technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. <h3>Conclusion</h3> This kind of surgery requires uncommon surgical skills and anatomical knowledge; we believe that it should be performed only in selected reference centers.

Assessment of Nerve Fiber Density and Expression of Hormonal Receptors Within Rectosigmoid Endometriosis Nodules

To assess nerve fiber density and expression of hormone receptors in bowel endometriosis. Cross-sectional study. Private hospital. Women with endometriosis undergoing laparoscopic segmental bowel resection (n=54). Tissue samples were obtained from patients with surgically treated rectosigmoid endometriosis. The rectosigmoid specimen containing the endometriosis nodule was manually sectioned and divided into 3 areas: core of the nodule, margin of the nodule, and healthy bowel tissue. The intensity of expression of estrogen and progesterone receptors was evaluated by immunohistochemistry and measured according to the Allred score. Nerve fibers were stained by immunohistochemistry using Protein Gene Product 9.5, and the density of nerve fillets was counted and expressed in number/mm². All glandular and stromal cells stained for estrogen; however, glandular cells stained more strongly than stromal cells (61.1% vs 35.2%; p=.01). Most of glandular and stromal cells stained strongly for progesterone receptors (90.7% vs 98.1%; p=.2). The density of nerve fibers was very high in the margin of the nodule (172.22±45.66/mm²), moderate in healthy bowel tissue (111.48±48.57/mm²), and very low in the core of the nodule (7.31±4.9/mm²); p=.01. Both glandular and stromal cells within the rectosigmoid endometriosis nodule express estrogen and progesterone receptors. Higher intensity of expression of estrogen receptors occurs in glandular cells. The density of nerve fibers is extremely high at the nodule margin and very low in the center of the nodule.

"The Sword in the Stone": radical excision of deep infiltrating endometriosis with bowel shaving-a single-centre experience on 703 consecutive patients.

Laparoscopic segmental bowel resection, disc excision and rectal shaving are described as surgical options for the treatment of bowel endometriosis, but the gold standard has not yet established. The aim of the study is to investigate the efficacy of the laparoscopic bowel shaving technique in terms of pain symptomatology and to analyse early and late postoperative complications. Retrospective cohort study of a series of 703 consecutive patients treated between January 2014 and December 2019 in a tertiary care referral centre. All patients underwent laparoscopic bowel shaving with concomitant radical excision of DIE. Bilateral posterolateral parametrectomy and ureterolysis were performed, respectively, in 314 (44.7%) and 318 cases (45.2%). A radical hysterectomy was performed in 107 cases (82.9%). Postoperative complications were infrequent: 17 patients required a reoperation (2.4%) and in this subgroup we registered 2 rectovaginal fistulas (0.3%), 4 patients received blood transfusion (0.6%), 12 patients (1.7%) experienced postoperative fever, 6 patients experienced impaired bladder voiding (0.9%) after 6months. Median follow-up was 14months. The study reported good clinical and surgical results, with a regression of symptoms (p < 0.0001) and an overall rate of recurrence of 6.5%. Clinical and instrumental criteria of bowel endometriosis relapse were exclusively detected in 5 patients (0.8%). Eleven patients (1.7%) with relapsed endometriosis were reoperated. Bowel shaving is a feasible and valuable surgical procedure. It is only the last step of a complex surgery which is aimed to minimize the residual quote of infiltrating nodule and requires a multidisciplinary team to achieve optimal treatment preoperatively, intraoperatively and postoperatively.

Postoperative Bowel Symptoms Improve over Time after Rectosigmoidectomy for Endometriosis

To evaluate bowel function (changes in stool caliber, sensation of incomplete evacuation, stooling frequency, and rectal bleeding) and urinary function (dysuria and retention) after segmental resection in patients with bowel endometriosis. Retrospective study. Tertiary hospital. A total of 413 (mean age = 33.6 ± 5.1 years) of reproductive aged women, with bowel endometriosis that underwent segmental bowel resection of the rectosigmoid from 2005 to 2018, without history of prior bowel surgery, without existing or history of malignancy. Laparoscopic segmental bowel resection performed by the same team and with the same technique. Data collected from the patients' records included length of resected segment, distance of the lesion from the anal verge, and complications. Information on intestinal and urinary function was obtained from a questionnaire applied before the surgery and at 2, 6, and 12 months after the surgery. There was a significant increase in the incidence of stool thinning and rectal bleeding 2 months after surgical procedure; these symptoms decreased significantly over time. The incidence of urinary symptoms decreased significantly over time after surgery. The length of the bowel segment resected was not associated with the postoperative symptoms, but the rectosigmoid lesion was significantly closer to the anal verge in patients with rectal bleeding and urinary symptoms. There was no association between the length of intestinal segment resected and the frequency of stooling. At 6 months, patients who had a decreased frequency of stooling underwent a resection closer to the anal verge (9.7 cm) in comparison with the ones with unchanged or increase frequency of stooling (10.1 cm and 10.7 cm, respectively; p <.05). Patient complaints on bowel and urinary alterations after segmental resection were transient with significant improvement over time up to 12 months. Bowel and urinary symptoms were not associated with the size of the bowel segment resected, whereas rectal bleeding at 2 months after surgery was significantly associated with the distance from anal verge. Segmental resection was also associated with a great improvement in constipation at 12 months postoperative.

Ghost Ileostomy in Anterior Resection for Bowel Endometriosis: Technical Description

ObjectiveTo demonstrate our application of the ghost ileostomy in the setting of laparoscopic segmental bowel resection for symptomatic bowel endometriosis nodule. DesignTechnical step-by-step surgical video description (educative video) SettingUniversity Tertiary Hospital. Institutional Review Board ruled that approval was not required for this study. Endometriosis affects the bowel in 3% to 37% of all cases, and in 90% of these cases, the rectum or sigmoid colon is also involved. Infiltration up to the rectal mucosa and invasion of >50% of the circumference have been suggested as an indication for bowel resection [1]. Apart from general risks (bleeding, infection, direct organ injuries) and bowel and bladder dysfunctions, anastomotic leakage is one of the most severe complications. In women with bowel and vaginal mucosa endometriosis involvement, there is a risk of rectovaginal fistula after concomitant rectum and vagina resections. Hence, for lower colorectal anastomosis, the use of temporary protective ileostomy is usually recommended to prevent these complications but carries on stoma-related risks, such as hernia, retraction, dehydration, prolapse, and necrosis. Ghost ileostomy is a specific technique, first described in 2010, that gives an easy and safe option to prevent anastomotic leakage with maximum preservation of the patient's quality of life [2]. In case of anastomotic leakage, the ghost (or virtual) ileostomy is converted, under local anesthesia, into a loop (real) ileostomy by extracting the isolated loop through an adequate abdominal wall opening. In principle, avoiding readmission for performing the closure of the ileostomy, with all the costs related, means a considerable saving for the hospital management.Also, applying a protective rectal tube in intestinal anastomosis may have a beneficial effect [3]. These options are performed by general surgeons in oncological scenarios, but their use in endometriosis has never been described. InterventionsIn a 32-year-old woman with intense dysmenorrhea, deep dyspareunia, dyschesia, and cyclic rectal bleeding, a complete laparoscopic approach was performed using blunt and sharp dissection with cold scissors, bipolar dissector and a 5-mm LigaSure Advance (Covidien, Valley lab, Norwalk, Connecticut). An extensive adhesiolysis restoring the pelvic anatomy and endometriosis excision was done. Afterward, the segmental bowel resection was performed using linear and circular endo-anal stapler technique with immediate end-to-end bowel anastomosis and transit reconstitution. Once anastomosis was done, the terminal ileal loop was identified, and a window was made in the adjacent mesentery. Then, an elastic tape (vessel loop) was passed around the ileal loop, brought out of the abdomen through the right iliac fossa 5-mm port site incision and, fixed to the abdominal wall using nonabsorbable stitches. Finally, a trans-anal tube was placed for 5 days. The patient was discharged on the fifth day postoperatively without any complications. The tape was removed 10 days after surgery, and the loop dropped back. Two months after the intervention, the patient remains asymptomatic. ConclusionGhost ileostomy is a simple, safe, and feasible technique available in the setting of lower colorectal anastomosis following bowel endometriosis resection.

Laparoscopic Segmental Resection for Deep Infiltrating Endometriosis of the Bowel: A Single Center Case Series of 2460 Consecutive Cases

Objective: To evaluate the efficacy of laparoscopic segmental bowel resection in patients with deep infiltrating endometriosis (DIE) with multivisceral involvement.

THE PRELIMINARY RESULTS OF OPERATION COLORECTAL ADENOMATOUS POLYPOSIS BY LAPAROSCOPY

Objective: To study the clinical characteristics, paraclinic, the operative indication and treatment outcomes operation of colorectal polyposis by laparoscopic. Marterials: 12 patients with colorectal polyposis, is surgically the subtotal colectomy, and the total colorectomy by laparoscopic from 11/2012 to 4/2015 at Digestive Surgical Department of Hue Central Hospital. Method: Prospective study, all patients were examined clinically, endoscopic colorectal, operative indication, the type of surgery, lengh of post-operative stay, complications, and pathology. Results: From 11/2012 to 4/2015. We had overalled 12 patients: 8 males and 4 females, the mean patient was 36.33 ± 19.5 years of age (15-71). Dyspepsia 66.7%, bloody stools 100%. Laparoscopic segmental bowel resection in four (33,3%) cases: right hemicolectomy in one (8.3%), resection of transverse colon in one (8.3%), left hemicolectomy in two (16.7%), and totally colorectomy in eight (66.7%) by laparoscopic surgery. The mean post-operative hospital stay was 10.1 ± 3.8 days. The early complication: fistula anastomosis in one (8.3%), patients recovered after conservative treatment, no bleeding and no wound infection. The pathology is adematous polyps 91.7% and hyperplasia polyps 8.3%. Conclusion: Laparoscopic surgery is currently the technique of choice. The resection of colorectal polyposis is the method safe, effective, high success, low rate complications. Key words: laparoscopic, polyposis, colo-rectal polyposis, hemicolectomy

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years.

Background. Laparoscopy or its combination with endoscopy is the next step for “difficult” polyps. The purpose of the paper was to review the outcomes of the laparoscopic approach to the management of “difficult” colorectal polyps.Materials and methods. From 2006 to 2016, 58 patients who underwent laparoscopic treatment for “difficult” polyps that could not be treated by endoscopy at the National Cancer Institute, Lithuania, were included. The demographic data, the type of surgery, length of post-operative stay, complications, and final pathology were reviewed prospectively.Results. The mean patient was 65.9 ± 8.9 years of age. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed in 15 (25.9%) patients, laparoscopic segmental bowel resection in 41 (70.7%) cases: anterior rectal resection with partial total mesorectal excision in 18 (31.0%), sigmoid resection in nine (15.5%), left hemicolectomy in seven (12.1%), right hemicolectomies in two (3.4%), ileocecal resection in two (3.4%), resection of transverse colon in two (3.4%), and sigmoid resection with transanal retrieval of specimen in one (1.7%). Two patients (3.4%) underwent laparoscopic-assisted endoscopic polypectomy. The mean post-operative hospital stay was 5.7 ± 2.4 days. There were four complications (6.9%). All patients recovered after conservative treatment. The mean polyp size was 3.5 ± 1.9 cm. Final histopathology revealed hyperplastic polyps (n = 2), tubular adenoma (n = 9), tubulovillous adenoma (n = 31), carcinoma in situ (n = 12), and invasive cancer (n = 4).Conclusions. For the management of endoscopically unresectable polyps, laparoscopic surgery is currently the technique of choice.

Feasibility and Safety of Laparoscopic-Assisted Bowel Segmental Resection for Deep Infiltrating Endometriosis: A Retrospective Cohort Study With Description of Technique

Study ObjectiveTo evaluate the feasibility and safety of laparoscopic segmental bowel resection for deep infiltrating endometriosis (DIE). DesignRetrospective clinical study (Canadian Task Force classification II-3). SettingEndoscopica Malzoni–Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. PatientsA retrospective cohort of 248 patients who underwent laparoscopic segmental bowel resection between January 1, 2011, and December 31, 2014. InterventionLaparoscopic segmental bowel resection for DIE. Measurements and Main ResultsBowel endometriosis was histologically confirmed in all 248 of the 248 patients (100%). The mean length of the resected specimens was 11.83 ± 4.56 cm. In all cases, margins were free of disease. The muscular layer was infiltrated up to the submucosal layer in all 248 patients (100%), whereas the mucosal layer showed signs of infiltration in only 4 patients (1.6%). Two nodules were found in 36 patients (14.5%), and 3 nodules were found in only 8 patients (3.2%). None of the resected bowel segments had nodules shorter than 3 cm, and the majority of lesions had a longitudinal diameter of 3 to 7 cm. In the majority of cases, resected segments involved the mid to low rectum (distance from the lower margin of resected segment from the anal verge of 4 to 12 cm), whereas in 6% of cases, ultra-low resections (≤4 cm) were performed.No intraoperative complications occurred, and conversion to laparotomy was not required for any patient. Major perioperative and early and late postoperative complications occurred in 20 patients (8.06%). Significantly reduced pain associated with disease was observed up to the 1-year follow-up irrespective of postoperative hormonal treatment. Pelvic relapse was found in up to 50% of patients, especially in patients without hormonal suppression, but only in the form of endometriomas or adherences, with no recurrent deep lesions observed. ConclusionThis large single-center series demonstrates that laparoscopic bowel resection for DIE is a feasible technique, with low complication rates. In symptomatic patients, treating deep fibrotic endometriosis nodules by laparoscopic segmental resection is very effective in reducing pain and restoring bowel function. This surgical approach is safe but complex, requiring specific skills in laparoscopic urologic and colorectal procedures, and should be performed only in specialized high-volume centers by high-volume surgeons.

Laparoscopic colorectal surgery for colorectal polyps: single institution experience.

IntroductionBecause of their difficult location or size, some polyps are impossible to remove with a flexible colonoscope and must be surgically removed. Laparoscopy is a great alternative.AimTo assess outcomes of a laparoscopic approach for the management of difficult colorectal polyps.Material and methodsFrom 2006 to 2014, patients with polyps that could not be treated by endoscopy were included. Demographic data, histology of the biopsy, type of surgery, length of postoperative stay, complications and final pathology were reviewed prospectively.ResultsForty-two patients with a mean age of 64.9 ±8.4 underwent laparoscopic polypectomy. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed for 12 (28.6%) polyps. Laparoscopic segmental bowel resection was performed in 30 (71.4%) cases: anterior rectal resection with partial total mesorectal excision in 12 (28.6%), left hemicolectomy in 7 (16.6%), sigmoid resection in 6 (14.3%), ileocecal resection in 2 (4.76%), resection of transverse colon in 2 (4.76%) and sigmoid resection with transanal retrieval of specimen in 1 (2.38%). Mean postoperative hospital stay was 5.9 ±2.6 days. There were 4 complications (9.5%). All patients recovered after conservative treatment. Mean polyp size was 3.6 ±2.2 cm. Final pathology revealed polyps (n = 2), tubular adenoma (n = 6), tubulovillous adenoma (n = 20), carcinoma in situ (n = 10) and invasive cancer (n = 4). Two of these patients underwent laparoscopic left hemicolectomies 14 and 10 days after laparoscopic colotomy and polypectomy.ConclusionsFor the management of endoscopically unresectable polyps, laparoscopic polypectomy is currently the technique of choice.

Laparoscopic treatment of deep infiltrating endometriosis: results of the combined laparoscopic gynecologic and colorectal surgery

The short-term results of a retrospective consecutive series of multidisciplinary laparoscopic approach to deep infiltrating endometriosis with intestinal involvement requiring segmental bowel resection procedures are presented. Patients with radiologically or intraoperative-confirmed endometriosis, who underwent a combined laparoscopic segmental bowel resection by a team of gynecologists and colorectal surgeons, were retrospectively reviewed. The postoperative data were collected in a specific database and analyzed for short-term (30 days) postoperative outcomes with the comparison between two specimen's extraction methods. Forty-one patients (median age of 36 years, range 25-44) have been operated by a combined team of gynecologist and colorectal surgeons. The median operative time was 247.5 min (range 155-375), and median estimated blood loss was 300 ml (range 100-1300). In 20 patients, the surgical specimens were extracted transvaginally, while in 21 cases, a sovrapubic transverse Pfannenstiel minilaparotomy was used. No intraoperative complications or conversion to laparotomy were reported. An acceptable cumulative rate of postoperative morbidity was observed (6/41, 15 %), without any postoperative deaths. Comparing the two subgroups of patients with different modalities of specimen retrieval, postoperative pain (assessed by visual analog scale) was significantly reduced in the transvaginal extraction group (median: 1 and range: 0-2 vs median: 3, 5 and range: 1-6; p = 0.002), without any statistically significant differences in terms of complications. Laparoscopic bowel segmental resection combined with gynecologic surgery for deep infiltrating endometriosis with intestinal involvement is a valid treatment option with a low rate of postoperative complications. Transvaginal specimen extraction allows the same results of minilaparotomic incision, minimizing surgical trauma and warranting a clear benefit in terms of reduction of postoperative pain.

Laparoscopic management of bowel endometriosis: resection margins as a predictor of recurrence.

To evaluate possible predictive factors for recurrence after laparoscopic segmental bowel resection for bowel endometriosis. Cohort study. Academic tertiary referral center. 95 symptomatic women with bowel endometriosis who underwent laparoscopic segmental bowel resection at the Endometriosis clinic, University of Berne, between 2002 and 2012 were enrolled. Since 14 women were lost to follow-up, 81 formed the final cohort. Clinical and histological characteristics were examined as possible predictive factors for disease recurrence. Recurrence, defined as a subsequent operation due to recurrent endometriosis-associated pain with a histologically confirmed endometriotic lesion. Recurrence was observed in 13 (16%) patients. Variables that were significantly associated to recurrence by the Cox regression analysis were positive bowel resection margins (hazard ratio 6.5, 95% confidence interval 1.8-23.5, p = 0.005), age <31 years (hazard ratio 5.6, 95% confidence interval 1.7-18.6, p = 0.005) and body mass index ≥23 kg/m(2) (hazard ratio 11.0, 95% confidence interval 2.7-44.6, p = 0.001). Positive bowel resection margins as well as age <31 years and body mass index ≥23 kg/m(2) appear to be independent predictors of disease recurrence.

Small Bowel Lymphangioma

BackgroundLymphangiomas are uncommon benign tumors found mainly in children. Intra-abdominal lymphangiomas are rare, mostly located in the mesentery. Small bowel lymphangiomas are very rare. Patient and methodsA 38-year-old woman presented with recurrent melena and anemia. Bidirectional endoscopy was non-diagnostic. Balloon enteroscopy revealed a 1 cm actively oozing, soft, friable, polypoid lesion in the proximal-mid small bowel. The lesion was white-yellow with “strawberry” mucosal patterns. Endoscopic tattooing was performed and she underwent subsequent laparoscopic segmental small bowel resection. ResultsHistopathologic features were consistent with a cavernous lymphangioma. At last follow-up, the patient's gastrointestinal (GI) bleeding and anemia had resolved. ConclusionsSmall bowel lymphangiomas can cause gross or occult GI bleeding, anemia, abdominal pain, and/or obstruction. Endoscopists should be aware of this rare tumor and its unique endoscopic features. The optimal treatment is radical excision, since incomplete resection may lead to recurrence. Argon plasma coagulation or polypectomy have been used to achieve endoscopic ablation and palliation of GI bleeding.

Fertility Outcome after Laparoscopic Segmental Bowel Resection for Endometriosis

Fertility Outcome after Laparoscopic Segmental Bowel Resection for Endometriosis

Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection

To present the clinical outcome after laparoscopic radical excision of deeply infiltrative endometriosis (DIE) with colorectal extension and laparoscopic segmental bowel resection. In three different studies including mostly patients with recurrent DIE with colorectal extension, we showed that radical reconstructive CO2 laser laparoscopic resection of DIE with colorectal extension in a multidisciplinary setting resulted in a low complication rate, a low cumulative reintervention and recurrence rate and a high cumulative pregnancy rate, also when bowel resection reanastomosis was performed. In a systematic review to assess the clinical outcome of surgical treatment of DIE with colorectal involvement, data were reported in such a way that comparison of different surgical techniques was not possible. A checklist is proposed to achieve standardized reporting of presenting symptoms, preoperative tests, inclusion criteria, preoperative and postoperative care, complications, follow-up, patient-centered assessment of pain and quality of life, fertility and recurrence corrected for postoperative use of hormonal suppression or infertility treatment. CO2 laser laparoscopic radical excision of DIE with colorectal extension and laparoscopic segmental bowel resection in centers of expertise is associated with good clinical outcome. To make real progress, international agreement is needed on terms and definitions used in surgical endometriosis research.

Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis

Laparoscopic segmental bowel resection and reanastomosis for endometriosis with colorectal wall invasion can be associated with high complication rates. This study was performed to test the hypothesis that this high complication rate can be prevented and combined with a good clinical outcome, following a multidisciplinary surgical approach. A retrospective cohort study of all patients with deep endometriosis and colorectal invasion treated by CO₂ laser laparoscopic radical excision between September 2004 and September 2006 (n = 45) to document the clinical outcome: complications, recurrence and fertility (life table analysis), pain, quality of life (QOL) and sexual function. No immediate major post-operative complications requiring surgical reintervention were recorded. Gynaecological pain (P < 0.0001), sexual function (P < 0.03) and QOL (P< 0.0001), improved significantly after a median follow-up period of 27 (range: 16-40) months. Although five patients (11%) had a surgical reintervention, histologically proven recurrent endometriosis was observed in only two (4%), with a cumulative endometriosis recurrence rate of 2.2 and 4.4% after 1 and 3 years, respectively. Thirteen of 28 patients who wanted to become pregnant conceived after surgery. One patient delivered twice. These 14 pregnancies were achieved spontaneously (n = 9) or after IVF (n = 5). The cumulative pregnancy rate was 47% after 3 years. Pain, sexual function and QOL improved significantly and were associated with a good fertility rate and a low complication and recurrence rate after a CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.

Deep pelvic endometriosis (Adamyan IV stage): Multidisciplinary laparoscopic treatments

Few small studies have confirmed the feasibility of laparoscopic colorectal resection for Deep Infiltrating Endometriosis (DIE), albeit with a wide range of complications. The aim of this study is to evaluate retrospectively the feasibility and clinical outcome of laparoscopic segmental bowel resection for DIE. We have retrospectively reviewed the data of patients undergoing laparoscopic rectosigmoidal resection for bowel endometriosis from January 2000 and June 2008. Data analysis included age, preoperative symptoms, operative procedure, operating room time, intraoperative and postoperative complication, length of stay and Quality of life. 56 colorectal laparoscopic resection for DIE were performed. No conversion occurred. There were no intraoperative complication; 35 patients had a temporary ileostomy and 15 required reoperation for major complication. DIE should be managed in specialised centers with a multidisciplinary equipe; it represents a difficult surgery which require a high surgeon skill and it must be practiced considering both the risks and the benefits.

Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: A review

Intestinal involvement in endometriosis is thought to occur in up to 12% of all endometriosis cases. While colorectal resection is being increasingly advocated as a feasible management option in patients with severe disease, there still remains significant resistance towards this surgery. This article aims to review the current literature to determine the pain and fertility outcomes following segmental bowel resection for colorectal endometriosis.

Laparoscopic Surgery For Adult Bowel Intussusception: Report Of A Case

Intussusception in adults is a rare entity that it is generally caused by definable intraluminal pathology and for this reason surgical resection of intussusception is usually indicated. The preoperative diagnosis of intussusception is infrequent in the adult population. The majority of patients are brought to the operating room with the preoperative diagnosis of bowel obstruction and the surgeon discovers an intussusception intraoperatively. We report a case of adult small bowel intussusception diagnosed preoperatively by CT scan of the abdomen and treated with laparoscopic segmental bowel resection.