Kahyaoğlu, Serkan Zekai Tahir Burak Women s Health Teaching and Research Hospital - Department of Obstetrics and Gynecology, Turkey

Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature

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Endometriosis is the presence of endometrial gland and stromal tissue outside the uterus with a potentially invasive nature despite being a benign disease process. The exact prevalence of the disease is not known but 10-15% of reproductive age women are affected. The peritoneal and rectovaginal endometriosis are two distinct entities of the disease with different symptoms and treatment strategies. Dyschezia and deep dyspareunia with nodularity on sacrouterine ligaments during rectovaginal examination are specific symptoms of deeply infiltrating endometriosis (DIE). Rectovaginal or bowel involvement is estimated to be present in 5 to 12 percent of women with endometriosis and the most common site is the rectosigmoid colon. Medical treatment of DIE with colorectal involvement results with symptomatic relief without any curative effect on endometriotic foci. Colorectal endometriosis treatment is a major challenge for the clinicians when incidentally encountered during a diagnostic laparoscopy. As randomised controlled studies comparing medical with surgical treatment for rectovaginal or bowel endometriosis are lacking; the impact of the surgical treatment modalities on clinical improvement of the symptoms, complications, recurrence and pregnancy rates is not known. Current literature indicates that, patients without bowel occlusion and/ or rectal bleeding with mucosal involvement caused by DIE should be treated with conservative technique specifically described as “shaving” method that have lower complication and recurrence rates than the invasive technique including bowel resection and anastomosis.

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Laparoscopy , gastrointestinal , rectovaginal , bowel endometriosis , surgical treatment

Cumhuriyet Medical Journal

287