Back to 2011 Program

Background: Bowel resection represents a safe and feasible option in treating severe bowel endometriosis and is associated with several well-known benefits. An abdominal incision is however needed for specimen extraction. Transvaginal approach can be an interesting approach for colorectal resections in order to avoid mini-laparotomy. Aim of this study is to evaluate our experience with laparoscopic transvaginal colorectal resection for bowel endometriosis. Methods: 40 patients (median age 30 years, range: 26-43) underwent laparoscopic colorectal resection for symptomatic deep infiltrating endometriosis of the rectum or rectosigmoid at a referral center. Laparoscopic intracorporeal division of the distal rectum and exteriorization of the surgical specimen via a colpotomy incision were performed in order to complete the resection. Transanal mechanical colorectal anastomosis was then carried out. All colorectal resections were performed by the same surgeon. Perioperative outcomes were analyzed.Results: 19 patients (47.5%) had previous laparotomic (n=3) or laparoscopic (n=16) surgery for endometriosis. All patients underwent laparoscopic removal of multiple implants of deep infiltrating pelvic endometriosis. No hysterectomy was performed and there was no conversion to laparotomy. At preoperative imaging 30 patients (75%) had bowel stenosis (median stenosis rate 55%; median length of stenosis 2.7 cm). All patients underwent a laparoscopic resection of the rectum or of the rectosigmoid, and low colorectal anastomoses was performed in 77.5% of patients. 12 patients (30%) had a temporary ileostomy. Median operative time (including both gynaecologic and colorectal surgery) was 330 minutes, and median blood loss was 280 mL. Median ileus was 3 days, median length of stay was 7 days. Mortality was nil, morbidity was 15%. Three patients developed recto-vaginal fistula and another one an anastomotic leakage. Overall, four patients (10%) required reoperation, and five required blood transfusions (12.5%). All major complications including recto-vaginal fistulas and anastomotic failure occurred in the first half of the groupConclusions: In the setting of deep infiltrating pelvic endometriosis, colorectal resection with a combined laparoscopic/transvaginal approach, avoiding a mini-laparotomy or the extension of port-site incisions, represent a viable option. All major complications occurred among the first half of our patients. A prospective randomized trial is necessary in order to properly evaluate the potential benefits of transvaginal versus laparotomic specimen extraction evaluating both perioperative and long-term outcomes.