Laparoscopic management of rectal endometriosis

PURPOSE: Surgical treatment of females with rectal endometriosis is challenging. The aim of this study was to review the results of laparoscopic intervention in the management of females with this complex disorder. METHOD: All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the rectum were identified and reviewed from a prospective database. RESULTS: Between April 1996 and August 2004, 95 patients with pelvic endometriosis involving the rectum had laparoscopic surgical procedures performed by one gynecologist and one colorectal surgeon. Eighty percent of rectal procedures were completed laparoscopically. Forty- three (45 percent) were treated with diathermy excision, 18 (19 percent) had shave partial-thickness disc excision, 20 ( 21 percent) had full- thickness disc excision (including 14 endoanally using a circular stapler), while 14 (15 percent) were managed with laparoscopic-assisted segmental low anterior resection. A history of rectal pain during defecation present only during menstruation (adjusted odds ratio = 8.6, 95 percent confidence interval (CI) = 1.8 - 41.2) and previous laparoscopy (adjusted odds ratio = 3.2, 95 percent CI = 1.2 - 8.3) independently predicted a need for more extensive surgery than diathermy excision. There were no rectal anastomoticleaks, with 8 percent overall morbidity. The only significant predictor of ongoing postoperative symptoms was a history of dyspareunia (P = 0.03). CONCLUSIONS: Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.