Laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis

Objectives To confirm the feasibility and safety of laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis. Setting Gynaecology and surgery departments at a university hospital. Subjects Between August 1997 and April 1999, five patients with symptomatic sigmoid endometriosis and concomitant pelvic endometriosis underwent LASSR. During that same period laparoscopic procedures for endometriosis involving the intestinal tract included: five anterior resections of the rectum with transanal end-to-end anastomosis for extensive rectosigmoid endometriosis, 26 resections of rectovaginal endometriotic nodules and one appendectomy. Interventions These included: laparoscopic dissection of the left large bowel from its adherent neighbouring structures, incision of the lateral and medial peritoneal reflections of the mesosigmoid, incision of the left paracolic gutter, identification of the left ovarian vessels and left ureter, extracorporeal resection of the sigmoid and lateroterminal handsewn anastomosis, and laparoscopic treatment of concomitant pelvic endometriosis. Results Neither intra- nor postoperative complications occurred. The mean operating time was 210 min. Postoperative ileus lasted less than 72 h in all cases (n = 5). The mean postoperative hospital stay was 6 days. There was no recurrence of sigmoid endometriosis symptoms over follow up for a mean of 15.2 months. Conclusions LASSR is a feasible and safe technique which is indicated for symptomatic sigmoid endometriosis. It allows the simultaneous laparoscopic management of pelvic endometriosis. Better cosmesis is an immediately recognizable benefit of this technique. Reduced postoperative pain and shortened postoperative ileus represent presumed advantages of LASSR compared with open surgery. The use of LASSR can help to reduce the cost of the laparoscopic instrumentation that is necessary for total laparoscopic colectomy.