Resection Of Endometriosis Research Articles

Rectal Endometriosis Resection: Repair with Barbed Suture

Rectal Endometriosis Resection: Repair with Barbed Suture

Two cases of placenta accreta identified during pregnancy after laparoscopic myomectomy and resection of adenomyosis

Two cases of placenta accreta identified during pregnancy after laparoscopic myomectomy and resection of adenomyosis

Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications

To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis. A multicenter case-controlled study using the prospectively collected data of 90 women (22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization (from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel dysfunction. A similar number of complicated cases have been registered for the different surgical techniques evaluated (laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated with endometriosis localization from the anal verge (OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation (11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03). Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications.

Clinical, Surgical and Quality of Life Outcomes Following Laparoscpic Excision of Endometriosis and Bowel Resection for Invasive Bowel Endometriosis

Clinical, Surgical and Quality of Life Outcomes Following Laparoscpic Excision of Endometriosis and Bowel Resection for Invasive Bowel Endometriosis

Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery.

To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis. Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months). Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8%) wishing to conceive, 12 (42.9%) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016). Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.

Standardized laparoscopic NOSE-colectomy is feasible with low morbidity.

In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy. Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity. A total of 110 patients were included in this study. Median age was 38 years (IQR: 32-56), median BMI was 23 kg/m(2) (IQR: 21-25), and 88% of the patients were female. Sixty-three patients (57%) underwent resection for endometriosis, 29 patients (26%) for diverticular disease, 16 patients (15%) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70-100) and median length of the extracted specimen was 20 cm (IQR: 16-25). Overall, 14 patients had a postoperative complication (13%), of which 9 were Clavien-Dindo grade 1 or 2 (8%). Four patients (3.6%) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1%), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4-6). Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.

Surgical and Clinical Impact of Extraserosal Pelvic Fascia Removal in Segmental Colorectal Resection for Endometriosis

Study ObjectiveTo describe the characteristics of patients with colorectal endometriosis and extraserosal pelvic fascia (EPF) involvement and to assess the effect of EPF resection. DesignProspective cohort study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsTwo hundred twenty-seven patients who underwent segmental colorectal resection to treat symptomatic deep infiltrating endometriosis between 2001 and 2011, with or without EPF resection. InterventionsSegmental colorectal resection with or without EPF resection. Measurements and Main ResultsOne hundred twelve patients (49.4%) required EPF resection. In these patients the total American Society for Reproductive Medicine endometriosis scores were higher (p = .004), there were more associated resected lesions of deep infiltrating endometriosis (p <.001), and the operative time was longer (p <.001). They were more likely to require blood transfusion (p = .003) and to experience intraoperative complications (p = .01) and postoperative voiding dysfunction (p = .04). ConclusionEPF infiltration reflects disease severity in patients with colorectal endometriosis. Its removal affects intraoperative morbidity and leads to a higher rate of voiding dysfunction.

Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting

Endometriosis as a benign disease appears frequently in premenopausal women with highly variable symptoms. In advanced stages bowel involvement is common. In symptomatic disease the adequate treatment requires complete resection of all residues. Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The purpose of this study was to show the feasibility of planned complete laparoscopic management of symptomatic deep pelvic endometriosis with bowel involvement performing segmental colorectal resection in a center of excellence. Between 2007 and 2012 all patients treated for symptomatic colorectal endometriosis in our institution were included and retrospectively evaluated. Laparoscopic excision of all visible disease was planned. Data analysis included age, previous history of endometriosis, intraoperative findings, operative procedure and intra- and postoperative complications. In this time period 35 patients with bowel infiltrating endometriosis were treated. Affected locations were the rectovaginal space in 31 patients (89 %), the rectum in 32 patients (91 %), the sigmoid colon in 10 patients (29 %), the coecum in 2 patients (5.7 %), the appendix in 3 patients (8.6 %) and the terminal ileum in 1 patient (2.9 %). In the majority of patients (85.7 %) the resection was achieved laparoscopically, in 3 patients a conversion to laparotomy was necessary and in 2 patients a primary laparotomia was performed. Complications occurred in 2 cases with anastomotic leakage in 1 patient (2.8 %) and a rectovaginal fistula in another patient. Radical resection was achieved in almost all patients (97 %). A well-trained interdisciplinary team can perform treatment of deep infiltrating endometriosis laparoscopically with low incidence of major complications as anastomotic leakage or rectovaginal fistula. Criteria of complete endometriosis restoration of the rectum can be achieved by total or subtotal rectal excision.

Robotic Assisted Resection of Diaphragmatic Endometriosis

Robotic Assisted Resection of Diaphragmatic Endometriosis

Experience with multidisciplinary laparoscopic surgery in patients with deep infiltrating colorectal endometriosis

Deep infiltrating endometriosis is a particular form of endometriosis that penetrates the peritoneal surface or it reaches the subserosal neurovascular plexus. The aim of the authors was to analyze the results of segmental colorectal resections performed for deep infiltrating endometriosis. Between 2009 and 2012, 50 patients underwent segmental rectum or/and sigmoid resection for endometriosis. 21 patients had ultralow rectal resection and 29 patients had low colorectal anastomosis or anterior resection. Concomitant intervention in other organs was required in all cases, including gynecologic procedures (n = 50), additional gynecologic (n = 47), vesical (n = 9) and ureteral (n = 18) resections. The mean number of endometriosis lesions was 2.4±1.8 per patient. In all patients fertility was preserved. Severe surgical complications (Clavien-Dindo stage III or more severe) occurred in 3 patients (6%). The results confirm that segmental bowel resection is an efficient and safe method for the treatment of deep infiltrating colorectal endometriosis. Orv. Hetil., 2014, 155(5), 182-186.

Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team.

Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.

Long-term outcome after laparoscopic bowel resections for deep infiltrating endometriosis: a single-center experience after 900 cases.

Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed. Results. The median follow-up was 54 months (range 1–120). All the evaluated symptoms significantly improved over time, with P = 0.0001 for dyspareunia, constipation, and pelvic pain and P = 0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P = 0.452 and P = 0.097, resp.). Conclusions. The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage.

Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis

Study ObjectiveTo evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis. DesignProspective cohort study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsAll patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France. Measurements and Main ResultsPatients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS. ConclusionOur results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.

Long-term efficacy and quality of life associated with laparoscopic bilateral uterine artery occlusion plus partial resection of symptomatic adenomyosis

ObjectiveTo assess the long-term efficacy and quality of life associated with laparoscopic bilateral uterine artery occlusion plus partial resection of symptomatic adenomyosis. Study designA total of 182 eligible patients with symptomatic adenomyosis were treated by laparoscopic bilateral uterine artery occlusion plus partial resection of adenomyosis from July 2003 to July 2009. Menstrual blood loss was measured using a pictorial blood loss assessment chart. Pain intensity during menstruation was evaluated on a 10-point visual analog scale (VAS). Health-related quality of life was measured using the WHOQOL-BREF. ResultsA total of 179 patients with 3 years follow-up were enrolled in this retrospective study. No severe complications were noted during the surgical procedure or follow-up period. The mean postoperative dysmenorrhea and menorrhagia scores were significantly improved (all p<0.01) at 3, 12 and 36 months postoperatively, compared with preoperative scores. The volume of the uterus was continuously reduced at 3, 6, 12 and 36 months postoperatively, and had shrunk by 58.3% at 36 months after surgery, compared with the preoperative volume. Notably, only 1.7% (3/179) of patients had received a hysterectomy at 36 months follow-up. In addition, patient's health-related quality of life scores were significantly increased (p<0.01) compared with preoperative scores. ConclusionLaparoscopic bilateral uterine artery occlusion plus partial resection of symptomatic adenomyosis is effective. There was a very low recurrence rate detected by ultrasound at 36 months.

Management of rectosigmoid obstruction due to severe bowel endometriosis

Bowel obstruction is a rare complication of intestinal endometriosis. The aim of this work was to evaluate outcomes after colorectal resection for bowel obstruction due to endometriosis. Of 720 patients who underwent colorectal resection for bowel endometriosis, 12 (1.7 %) presented with bowel obstruction. Preoperative work-up, management, perioperative and long-term outcomes were analyzed. All lesions were localized in the rectosigmoid tract. All patients underwent colorectal resection, which was carried out laparoscopically in 4 (33 %). Rate of low or ultra-low colorectal anastomoses was 83 %. Four patients (33 %) required blood transfusions. Two patients developed rectovaginal fistulas. After a median follow-up of 38 months, there were no cases of disease recurrence and dyschezia improved in 75 % of patients. Bowel endometriosis should be considered in the differential diagnosis of young women with bowel obstruction. Despite challenging operations, colorectal resections are associated with good outcomes.

Systematic review of the outcome associated with the different surgical treatment of bowel and rectovaginal endometriosis

Background: Treatment of deep endometriosis involving the bowel is controversial. There is limitation of medical treatment. Several surgical techniques are used. All of them are associated with potential intraoperative complications and long-term hazards for the bladder, bowel and sexual function. Objectives: This study seeks to review systematically different types of surgical treatment of bowel endometriosis which include mucosal skinning (shaving), disc excision, and segmental resection. The review includes the number of participants, histology, symptomatology, preoperative assessment, types and access of surgery, complications, hospital stay, length and way of follow up, symptom improvement, recurrence, and effects on fertility. Study strategy: All published articles on surgical treatment of endometriosis (shaving, rectovaginal endometriosis, disc excision, and segmental resection), identified through MEDLINE, EMBASE, CINAHL, and Cochran library during 1970–2011. Grey literatures were searched as well. Selection criteria: The terms ‘endometriosis’, ‘bowel’, surgical, and complications were used. Articles describing 50 patients or more who had bowel surgery for endometriosis were only included. Data collection and analysis: Data did not permit a meaningful meta-analysis. Main results: We analyzed 36 articles after thorough literature search. It described 2,414 of mucosal skinning/rectovaginal endometriosis, 381 of disc excision, and 2,728 of bowel resection for deep endometriosis involving the bowel. The indication for surgery was stated in most of the studies. Histology was confirmed in the majority; however, completeness of the excision was stated in few articles. There is significant improvement of symptoms with all types of surgery. Complications were higher in segmental resection than conservative surgery (shaving and disc excision) especially leakage and fistula formation. The duration of surgery and hospital stay was shorter in conservative surgery unless there were complications or if associated with other surgeries. Fertility outcome was favourable in all. The recurrence and reoperation rate was higher in one study only in the shaving group, but otherwise was comparable to the resection group. Conclusion: There was no difference in the outcome between different types of surgery which indicates that we should adopt the conservative surgery if possible. The heterogeneity of the studies makes it difficult to do any valuable statistical analysis. There should be standardization in clinical trials evaluating bowel surgery for endometriosis.

Robotic Assisted Colorectal Resection of Intestinal Endometriosis. Single Center Experience with 11 Cases

Robotic Assisted Colorectal Resection of Intestinal Endometriosis. Single Center Experience with 11 Cases

Fertility Outcome after Laparoscopic Segmental Bowel Resection for Endometriosis

Fertility Outcome after Laparoscopic Segmental Bowel Resection for Endometriosis

Pelvic Sidewall Anatomy

Endometriosis can alter pelvic anatomy. Thus, it is important to be aware of key structures during the resection of endometriotic implants. Knowledge of the anatomy may decrease potential injury to these structures. This video highlights the ureter, obliterated umbilical artery, uterine artery, pelvic floor muscles, external iliac vessels and obturator vessels and nerve during a resection of endometriosis of the left pelvic sidewall. Our video aims to show the relationship of these structures to each other as show partial dissection of the pelvic sidewall.

TLH BSO with Bowel Resection for Advanced Endometriosis Using a “Dental Floss Dunk” Technique

This case demonstrates a technique for removing a rectal endometriosis nodule by “dunking” it with suture placed in the jaws of a circular stapler like dental floss. The surgery also demonstrates opening the avascular spaces of the pelvis--pararectal, paravesical, vesicovaginal, and rectovaginal--in a systematic way to ensure safe and complete endometriosis resection.