Colorectal endometriosis

Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis

Anterior discoid resection is associated with a shorter operative time, lower blood loss, shorter hospital stay, and lower rate of anastomotic strictures than laparoscopic anterior resection is in the treatment of rectal endometriosis.

Objective:

To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR).

Methods:

This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital. Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared.

Results:

Twenty-two patients underwent laparoscopic ADR (n=8) or LAR (n=14) for rectosigmoid endometriosis between January 2001 and December 2009. Mean follow-up time was 41.26 months (range, 14 to 70). Patients undergoing laparoscopic ADR had significantly less blood loss and shorter operative time and hospital stay. Patients who required LAR had a significantly higher rate of mucosal involvement (61.5% v. 0%). No statistically significant difference was found in the size, depth of invasion, location of lesions, or operative complications. Fifty percent of the LAR group had several lesions as opposed to 12.5% of the ADR group. Median age was significantly higher in patients who required LAR (39) than in patients who required ADR (32). Three patients in the LAR group (21.4%) had anastomotic strictures; 2 required dilation. The ADR group had consistently higher increments of improvement in bowel symptoms and dyspareunia. Overall satisfaction rate with the procedures was 93.3%. SF-12 scores were comparable between the 2 groups.

Conclusion:

ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.

Laparoscopic colorectal resection for endometriosis

BACKGROUND

The rectosigmoid colon is affected by deep pelvic endometriosis in 3-37% of cases. In the past, treatment of the affected gastrointestinal tract generally required conversion to conventional surgery. We describe our experience with complete laparoscopic management of deep pelvic endometriosis with bowel involvement.

METHODS

From March 1995 to March 2003, 29 consecutive patients with endometriosis requiring laparoscopic intervention were evaluated. In seven patients (24%) colorectal involvement was identified prior to the operation. A low anterior resection was performed in four patients (57%) and a sigmoid resection in three (43%). In all cases, colonoscopy showed a normal mucosa. In all cases, treatment consisted of resection of the bowel involved together with the excision of all other implants. Data analysis included age, previous abdominal operations, previous history of endometriosis, operative time, conversion rate, complications, length of stay, and pain relief.

RESULTS

There were seven patients with colorectal involvement whose median age was 32.8 years (range, 28-40), with a history of previous abdominal operation in two (28%). Preoperative symptoms were as follow: dysmenorrea in four patients (57%), dyspareunia in four (57%), pelvic pain in seven (100%), rectal bleeding in one (14%), and tenesmus in five (71%). Mean operative time was 190 min (range, 165-230). Length of stay was 8.3 days (range, 7-11). There were no anastomotic leak and no major postoperative complication. One patient had temporary urinary retention. At a median follow-up of 38.7 months (range, 1-84), complete relief of pelvic symptoms was achieved in five patients (71%), and there was improvement in one patient. In one patient complaining of persistent pain, a new colonic implant was diagnosed two years after the surgery requiring reoperation.

CONCLUSIONS

The results show that provided that the surgeon is highly skilled in laparoscopy, laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement is feasible and effective in nearly all patients.

Endometriosis. An important condition in clinical gastroenterology

Endometriosis, a condition defined by the presence of ectopic endometrium, is a disorder of increasing incidence and a significant cause of gastroenterologic distress in young women. Although clinical manifestations vary considerably depending upon the anatomic extent of disease, characteristic abdominal complaints and typical physical findings continue to be associated with misdiagnosis and delayed recognition of gastrointestinal involvement. The authors of this paper review the medical literature concerning endometriosis of the digestive tract--emphasizing modes of presentation, risk factors, diagnostic testing, complications, and therapy. Greater familiarity with the disease and heightened awareness of its sequellae are needed and prerequisite to improved medical management.

Endometriosis of the colon

A case of endometriosis of the colon is presented. The incidence, symptomatology and treatment are discussed.