Laparoscopic anterior resection of the rectum and hysterectomy in a patient with extensive pelvic endometriosis

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Abstract

Objective

To assess the feasibility of excising rectal endometriosis using laparoscopic techniques and reanastomosing the rectum using a circular stapling device.

Subject

A 41-year-old woman with recurrent stage IV endometriosis (revised American Fertility Society classification).

Interventions

Laparoscopic excision of stage IV endometriosis, laparoscopic hysterectomy, right salpingo-oöphorectomy, appendicectomy, anterior rectal resection and reanastomosis with circular stapler.

Main outcome measures

Surgical outcome, involvement of endometriosis, operative time, duration of hospital stay, complications, histological involvement of organs with endometriosis and 1-year follow up.

Results

The procedure was uncomplicated and took 3h to complete. The patient was discharged home on day 4. Histological analysis revealed endometriotic involvement through to the rectal mucosa and also of the appendix. The uterus revealed adenomyosis. At 1-year follow up, the patient was free from the symptoms associated with her pelvic endometriosis

Conclusions

Laparoscopic anterior resection of the rectum using a stapler fashioned to provide an end-to-end anastomosis was performed in association with a total laparoscopic hysterectomy. Advanced rectovaginal endometriosis may involve the full thickness of the rectal wall, the endometriosis may be excised laparoscopically and the rectal disease can be excised without performing a laparotomy. By avoiding the need for laparotomy, this allows the patient the advantages of reductions in pain, hospital stay and duration of convalescence.

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