A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis

Objective: To present our experience with anew technique for laparoscopic rectosigmoid resection inpatients with endometriosis. Design: Prospective collaborative cohort study. Setting: Gynecologic departments of two university hospitals. Patient(S): Thirty-three women with rectosigmoid endometriotic lesions requiring segmental bowel resection. Intervention(S): Laparoscopic intracorporeal division of the distal bowel and exteriorization of the affected segment via a colpotomy incision to complete the resection. Main Outcome Measure(s): Intraoperative and postoperative complications, and relief from symptoms. Result(S): The only intraoperative complication was bleeding from the inferior mesenteric artery that required conversion to laparotomy to obtain hemostasis. No patient required a temporary colostomy. No anastomotic complications were identified. Postoperative complications included a symptomatic pelvic seroma that required operative drainage in I patient and urinary retention that required intermittent self-catheterization in 3 women. The median follow-up duration was 13 months (range, 3-27 mo). Twenty-seven women were symptom free at the time of last follow-up evaluation. No patient had recurrent cyclic rectal bleeding, rectal pain on defecation, or tenesmus. Postoperatively, 4 of 13 patients who tried to conceive were successful. Conclusion(s): Segmental colorectal resection with a combined laparoscopic-transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis. (Fertil Steril (R) 2008;90:1964-8. (C)2008 by American Society for Reproductive Medicine.)