The incidence of endometriosis varies from 5 to 10% of the women and some grade of intestinal involvement is found in about 6 to 30 % of these patients.In symptomatic patients, when the endometriotic tissues invade deeply the intestinal wall, the treatment may include an intestinal resection.
Aim: The purpose of this study is to review the indications and results of the laparoscopic treatment in a series of patients with intestinal endometriosis.
Patients and Methods:From October 2002 to November 2006, 64 patients with deep involvement of the intestinal wall were treated by the same multidisciplinary surgical team. The patients’ age was from 26 to 42 years old, and all of them had presented clinical signs, laboratorial and image exams suggesting intestinal endometriosis.
Results:The rectum was the most frequent infiltration site, observed in 56 patients. The terminal ileum was compromised in two, the appendix in five and the sigmoid colon in one patient.Laparoscopic rectal resection was done in 57 cases. In one patient, due to a difficult application of the stapler, the option was the extension of the suprapubic incision in order to achieve a better stapling. Lighted ureteral stents were inserted before the beginning of the surgery in 14 patients in order to avoid ureteral damage. Other resections that were done included: one sigmoidectomy, five appendectomy, two segmental resection of the ileum and two right colectomy. The operation time ranged from 100 to 270 minutes and hospital stay lasted from four to six days. The most important complication was the transection of the right ureter in one patient. In one patient the surgery were converted to laparotomy. Pseudo-membranous colitis was diagnosed and treated in another case and other patient had a stenosis of the colorectal anastomosis, treated by endoscopic dilation.
Conclusions:Endometriosis can involve the intestinal tract, more often the rectum. Laparoscopic surgery permits adequate treatment and good postoperative recovery. The notion that major complications may occur should be a determining factor in the decision to have such complex cases treated by a specialized multidisciplinary team.