Laparoscopic Disk Resection for Bowel Endometriosis Using a Circular Stapler and a New Endoscopic Method to Control Postoperative Bleeding from the Stapler Line
Received 26 December 2007; received in revised form 19 February 2008; accepted 27 February 2008. published online 20 May 2008.
Background
Complete laparoscopic excision of endometriosis offers good longterm symptomatic relief, especially for those with severe or debilitating symptoms. Intestinal endometriosis affect between 3% and 36% of women with endometriosis and 50% of women with disease severe enough that intestinal surgery, with or without intestinal segmental resection, may be required.
Study Design
Between January 2003 and September 2006, we performed 35 laparoscopic complete excisions of endometriosis with full thickness disk resections of bowel endometriosis using the CEEA stapler (US Surgical) inserted transanally.
Results
The endometriotic nodule of the bowel was completely removed in all patients. No major or minor surgical complications occurred during the primary surgical procedure. One patient underwent a diverting temporary ileostomy because of air loss after insufflation of the rectosigmoid colon, which was closed successfully 1 month after surgery. In three of seven cases of rectal bleeding from the stapler line, for the first time, we successfully used conservative endoscopic management.
Conclusions
In properly selected patients, full thickness disk excision using a circular stapler is a feasible procedure that avoids the potential morbidities of a low anastomosis. We suggest conservative management by endoscopic hemostasis before referring patients for a new operation in cases of rectal bleeding from the anastomotic site.
aDepartment of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar (Verona), Italy
bDepartment of General Surgery, Ospedale Sacro Cuore, Negrar (Verona), Italy
cDepartment of Digestive Endoscopy Unit, Ospedale Sacro Cuore, Negrar (Verona), Italy
dDepartment of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashome, Israel.
Correspondence address: Giovanni Pontrelli, MD, Departments of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don A Sempreboni 5, 37024 Negrar (Verona), Italy.
ABSTRACT