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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2015

01-10-2015

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

Authors: Stefano Rausei, Daniele Sambucci, Sebastiano Spampatti, Elisa Cassinotti, Gianlorenzo Dionigi, Giulia David, Fabio Ghezzi, Stefano Uccella, Luigi Boni

Published in: Surgical Endoscopy | Issue 10/2015

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
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Metadata
Title
Laparoscopic treatment of deep infiltrating endometriosis: results of the combined laparoscopic gynecologic and colorectal surgery
Authors
Stefano Rausei
Daniele Sambucci
Sebastiano Spampatti
Elisa Cassinotti
Gianlorenzo Dionigi
Giulia David
Fabio Ghezzi
Stefano Uccella
Luigi Boni
Publication date
01-10-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-4018-4

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