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

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 TV endometriosis, laparoscopic hysterectomy, right salpingo-oophorectomy, 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 3 h 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.