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Hum. Reprod. Advance Access published online on February 16, 2009
Human Reproduction, doi:10.1093/humrep/dep016
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Treatment of endometriosis of uterosacral ligament and rectum through the vagina: description of a modified technique

O. Camara1, J. Herrmann1, A. Egbe1, A. Kavallaris1, H. Diebolder1, M. Gajda2 and I.B. Runnebaum1,3

1 Department of Gynaecology, Friedrich-Schiller-University, Bachstrasse 18, 07743 Jena, Germany 2 Department of Pathology, Friedrich-Schiller-University, Ziegelmuehlenweg 1, 07740 Jena, Germany

3 Correspondence address. Tel: +49-3641-933063; Fax: +49-3641-933064; E-mail: ingo.runnebaum{at}med.uni-jena.de

BACKGROUND: Endometriosis is common in women of childbearing age, whereas involvement of the rectosigmoid requiring resection is rare. Laparoscopy has become a standard procedure in the management of endometriosis. The optimum way to diagnose endometriosis is by direct visualization of the implants. Usually for the removal of the specimen, an additional larger abdominal incision is needed.

METHODS: Here we report on cases of four patients with a uterosacral ligament and rectal endometriosis who were successfully treated with combined laparovaginal resection, using a modification of an existing technique. They had been complaining of rectal bleeding and lower abdominal pain in relation to their menstrual cycle. The aim of this technique is to achieve a careful and margin-free resection of the area involved. This can be done without any large incisions of the abdominal wall. The hypogastric nerves remain preserved on both sides.

RESULTS: The intra- and post-operative courses were uneventful. No blood transfusions were needed. Haemoglobin decrease was usually ≤1 mmol/l. The average tumour diameter was 3.5 cm.

CONCLUSIONS: Our technique circumvents a larger abdominal incision. This combined laparoscopic–transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis.

Key words: rectal wall endometriosis/laparoscopy/circular stapler/uterosacral ligament/hypogastric nerve

Submitted on September 26, 2008; resubmitted on January 8, 2009; accepted on January 13, 2009.


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