Presentation Information
[ICS-5]Surgical Strategies for Bowel Management in Deep Infiltrating Endometriosis
Radek Chvatal1, Miroslav Kavka1 (1.District Hospital Znojmo, 2.District Hospital Znojmo)
Study Objective
The prevalence of endometriosis in highly developed countries is alarming. An estimated 40% of women of childbearing age are affected by endometriosis to some degree. The primary contributing factor is delayed first pregnancy, among others. Endometriosis has become not only a medical issue but also a socioeconomic concern. When considering deep infiltrating endometriosis (DIE) of the pelvis, infiltration of the rectovaginal septum is of particular importance. In such cases, close cooperation between gynecologists and surgeons is essential. As we are treating young patients, it is crucial to preserve hypogastric innervation, the ureters, and the vagina. Rectovaginal nodules typically infiltrate both of these structures. For preoperative diagnosis, we rely on ultrasound, MRI, rectoscopy, and combined vaginal and rectal examinations.
Setting
Our hospital operates a dedicated center for the treatment of endometriosis. Over the past 11 years, we have performed more than 100 laparoscopic procedures for rectovaginal septum endometriosis. The gynecologist is responsible for dissecting the rectosigmoid, performing ureterolysis and neurolysis, and, if necessary, resecting the posterior vaginal vault. The surgeon determines the most appropriate surgical method based on the extent of infiltration. There are three main approaches: (A) shaving, (B) discoid resection, and (C) rectosigmoid resection with end-to-end anastomosis. We have not encountered any major complications. Anastomotic leakage occurred in 8% of cases, and minor bladder denervation was observed rarely. It is important to note that these patients are often infertile and seeking pregnancy. In cases of pregnancy, cesarean section is inevitable.
Conclusion
Rectovaginal DIE is a serious condition, and surgical treatment invariably leaves some sequelae. The expertise, cooperation, and mutual understanding of the surgical team play a crucial role in achieving optimal outcomes.
Keywords:
deep infiltrating endometriosis (DIE), rectosigmoid, innervation
The prevalence of endometriosis in highly developed countries is alarming. An estimated 40% of women of childbearing age are affected by endometriosis to some degree. The primary contributing factor is delayed first pregnancy, among others. Endometriosis has become not only a medical issue but also a socioeconomic concern. When considering deep infiltrating endometriosis (DIE) of the pelvis, infiltration of the rectovaginal septum is of particular importance. In such cases, close cooperation between gynecologists and surgeons is essential. As we are treating young patients, it is crucial to preserve hypogastric innervation, the ureters, and the vagina. Rectovaginal nodules typically infiltrate both of these structures. For preoperative diagnosis, we rely on ultrasound, MRI, rectoscopy, and combined vaginal and rectal examinations.
Setting
Our hospital operates a dedicated center for the treatment of endometriosis. Over the past 11 years, we have performed more than 100 laparoscopic procedures for rectovaginal septum endometriosis. The gynecologist is responsible for dissecting the rectosigmoid, performing ureterolysis and neurolysis, and, if necessary, resecting the posterior vaginal vault. The surgeon determines the most appropriate surgical method based on the extent of infiltration. There are three main approaches: (A) shaving, (B) discoid resection, and (C) rectosigmoid resection with end-to-end anastomosis. We have not encountered any major complications. Anastomotic leakage occurred in 8% of cases, and minor bladder denervation was observed rarely. It is important to note that these patients are often infertile and seeking pregnancy. In cases of pregnancy, cesarean section is inevitable.
Conclusion
Rectovaginal DIE is a serious condition, and surgical treatment invariably leaves some sequelae. The expertise, cooperation, and mutual understanding of the surgical team play a crucial role in achieving optimal outcomes.
Keywords:
deep infiltrating endometriosis (DIE), rectosigmoid, innervation