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Archives of Gynecology and Obstetrics

, Volume 289, Issue 6, pp 1241–1247 | Cite as

Feasibility and first long-term results after laparoscopic rectal segment resection and vaginal specimen retrieval for deep infiltrating endometriosis

  • M. C. Fleisch
  • P. Hepp
  • T. Kaleta
  • J. Schulte am Esch
  • D. Rein
  • T. Fehm
  • I. Beyer
General Gynecology

Abstract

Introduction

Radical resection of deep infiltrating endometriosis (DIE), including bladder and bowel resection, provides relief from pain in symptomatic patients. The laparoscopic approach to treatment is well established for bowel resection but normally requires additional abdominal incisions for specimen retrieval. Here we describe our technique of laparoscopically assisted rectal resection and transvaginal specimen retrieval (LARRT) and provide follow-up information on pain scores and complications.

Materials and methods

Retrospective observational monocentric study on all DIE patients with rectal infiltration treated between 2008 and 2010 with LATRR at our department. Follow-up was obtained for at least 3 years, including baseline 1-year and 3-year pain scores.

Results

We identified four patients undergoing LARRT available for follow-up. DIE was confirmed by histology in all cases. There were no intraoperative complications. Two patients had transient postoperative urinary retention, one patient developed recto-vaginal fistula and required transient colostomy. One patient suffered from persistent vaginal dryness. All patients, however, reported persistent pain relief, including at the end of follow-up period.

Conclusion

LARRT is a feasible variation of laparoscopic bowel resection for DIE with rectal infiltration. In our study it has promising results with respect to pain control. Larger studies will, however, be required to determine the safety of this procedure.

Keywords

Deep infiltrating endometriosis ENZIAN Rectum Laparoscopy 

Notes

Conflict of interest

None.

Supplementary material

Supplementary material 1 (WMV 62,242 kb)

References

  1. 1.
    Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21:1243–1247PubMedCrossRefGoogle Scholar
  2. 2.
    Darai E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023PubMedCrossRefGoogle Scholar
  3. 3.
    Darai E, Carbonnel M, Dubernard G, Lavoue V, Coutant C, Bazot M, Ballester M (2010) Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis. Eur J Obstet Gynecol Reprod Biol 149:210–214PubMedCrossRefGoogle Scholar
  4. 4.
    Keckstein J, Wiesinger H (2005) Deep endometriosis, including intestinal involvement–the interdisciplinary approach. Minim Invasive Ther Allied Technol 14:160–166PubMedCrossRefGoogle Scholar
  5. 5.
    Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96:304–307PubMedCrossRefGoogle Scholar
  6. 6.
    Chapron C, Jacob S, Dubuisson JB, Vieira M, Liaras E, Fauconnier A (2001) Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum. Acta Obstet Gynecol Scand 80:349–354PubMedGoogle Scholar
  7. 7.
    Chapron C, Chopin N, Borghese B, Malartic C, Decuypere F, Foulot H (2004) Surgical management of deeply infiltrating endometriosis: an update. Ann NY Acad Sci 1034:326–337PubMedCrossRefGoogle Scholar
  8. 8.
    Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400PubMedCrossRefGoogle Scholar
  9. 9.
    Fleisch MC, Xafis D, De Bruyne F, Hucke J, Bender HG, Dall P (2005) Radical resection of invasive endometriosis with bowel or bladder involvement—long-term results. Eur J Obstet Gynecol Reprod Biol 123:224–229PubMedCrossRefGoogle Scholar
  10. 10.
    Vercellini P, Pietropaolo G, De GO, Daguati R, Pasin R, Crosignani PG (2006) Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 195:1303–1310PubMedCrossRefGoogle Scholar
  11. 11.
    Wood SG, Panait L, Duffy AJ, Bell RL, Roberts KE (2013) Complications of transvaginal natural orifice transluminal endoscopic surgery: a series of 102 patients. Ann Surg [Epub ahead of print]Google Scholar
  12. 12.
    Nezhat C, Pennington E, Nezhat F, Silfen SL (1991) Laparoscopically assisted anterior rectal wall resection and reanastomosis for deeply infiltrating endometriosis. Surg Laparosc Endosc 1:106–108PubMedCrossRefGoogle Scholar
  13. 13.
    Nezhat F, Nezhat C, Pennington E (1992) Laparoscopic proctectomy for infiltrating endometriosis of the rectum. Fertil Steril 57:1129–1132PubMedGoogle Scholar
  14. 14.
    Nezhat F (2001) Laparoscopic segmental resection for infiltrating endometriosis of rectosigmoid colon: a preliminary report. Surg Laparosc Endosc Percutan Tech 11:67–68PubMedGoogle Scholar
  15. 15.
    Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 195:754–758PubMedCrossRefGoogle Scholar
  16. 16.
    Abrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA Jr (2005) Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet 91:27–31PubMedCrossRefGoogle Scholar
  17. 17.
    Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F, Dionigi R, Ghezzi F (2007) Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 16(Suppl 1):S157–S160PubMedCrossRefGoogle Scholar
  18. 18.
    Camara O, Herrmann J, Egbe A, Kavallaris A, Diebolder H, Gajda M, Runnebaum IB (2009) Treatment of endometriosis of uterosacral ligament and rectum through the vagina: description of a modified technique. Hum Reprod 24:1407–1413PubMedCrossRefGoogle Scholar
  19. 19.
    Ebert AD, Burkhardt T, Parlayan S, Riediger H, Papadopoulos T (2009) Transvaginal-laparoscopic anterior rectum resection in a hysterectomized woman with deep-infiltrating endometriosis: description of a gynecologic natural orifice transendoluminal surgery approach. J Minim Invasive Gynecol 16:231–235PubMedCrossRefGoogle Scholar
  20. 20.
    Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90:1964–1968PubMedCrossRefGoogle Scholar
  21. 21.
    Kavallaris A, Chalvatzas N, Hornemann A, Banz C, Diedrich K, Agic A (2011) 94 months follow-up after laparoscopic assisted vaginal resection of septum rectovaginale and rectosigmoid in women with deep infiltrating endometriosis. Arch Gynecol Obstet 283:1059–1064PubMedCrossRefGoogle Scholar
  22. 22.
    Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HR (2005) ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 127:275–281PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium (2013) Consensus on current management of endometriosis. Hum Reprod 28:1552–1568PubMedCrossRefGoogle Scholar
  24. 24.
    Ballester M, d’Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E (2012) Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod 27:1043–1049PubMedCrossRefGoogle Scholar
  25. 25.
    Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37:747–753PubMedCrossRefGoogle Scholar
  26. 26.
    Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21:1572–1577PubMedCrossRefGoogle Scholar
  27. 27.
    Ford J, English J, Miles WA, Giannopoulos T (2004) Pain, quality of life and complications following the radical resection of rectovaginal endometriosis. BJOG 111:353–356PubMedCrossRefGoogle Scholar
  28. 28.
    Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L (2010) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24:63–67PubMedCrossRefGoogle Scholar
  29. 29.
    Seracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, Remorgida V, Mabrouk M, Venturoli S (2007) Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG 114:889–895PubMedCrossRefGoogle Scholar
  30. 30.
    Urbach DR, Reedijk M, Richard CS, Lie KI, Ross TM (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum 41:1158–1164PubMedCrossRefGoogle Scholar
  31. 31.
    Nezhat C, Nezhat F, Pennington E, Nezhat CH, Ambroze W (1994) Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis. Surg Endosc 8:682–685PubMedCrossRefGoogle Scholar
  32. 32.
    Kondo W, Ribeiro R, Trippia C, Zomer MT (2013) Laparoscopic treatment of deep infiltrating endometriosis affecting the rectosigmoid colon: nodulectomy or segmental resection? Gynecol Obstet S3:001Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. C. Fleisch
    • 1
  • P. Hepp
    • 1
  • T. Kaleta
    • 1
  • J. Schulte am Esch
    • 2
  • D. Rein
    • 3
  • T. Fehm
    • 1
  • I. Beyer
    • 1
  1. 1.Department of Obstetrics and GynecologyHeinrich-Heine-University Medical CentreDuesseldorfGermany
  2. 2.Department of Colorectal SurgeryHeinrich-Heine-University Medical CentreDuesseldorfGermany
  3. 3.Department of Obstetrics and GynecologyElisabeth-KrankenhausCologne-HohenlindGermany

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