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

Year 2014, Volume: 36 Issue: 2, 281 - 287, 27.06.2014
https://doi.org/10.7197/cmj.v36i2.1008002531

Abstract

Abstract

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.

Keywords: Laparoscopy, gastrointestinal, rectovaginal, bowel endometriosis, surgical treatment

 

Özet

Endometriozis iyi huylu bir hastalık prosesi olmasına rağmen endometrial gland ve stromanın uterus dışında potansiyel olarak invazif bir davranışla bulunmasıdır. Hastalığın kesin prevelansı bilinmemektedir fakat üreme çaındaki kadınların yaklaşık %10-15’i etkilenmiştir. Peritoneal ve rektovajinal endometriozis hastalığın farklı semptom ve tedavi stratejileri olan iki ayrı antitesidir. Rektovajinal muayene sırasında sakrouterin ligamentlerde nodülarite ile beraber diskezi ve derin disparanü derin infiltratif endometriozisin (DİE) spesifik semptomlarıdır. Endometriozisli hastaların yaklaşık %5-12’sinde rektovajinal veya barsak tutulumu mevcut olduğu tahmin edilmektedir ve en sık tutulan bölge rektosigmoid kolondur. Kolorektal tutumlu DİE’nin tıbbi tedavisi endometriotik odaklar üzerinde herhangi bir küratif etki etmeden semptomatik rahatlama sağlar. Tanısal bir laparoskopi sırasında tesadüfen saptandığında kolorektal endometriozis tedavisi klinisyenler için major bir sorundur. Rektovajinal veya barsak endometriozisinin medikal ve cerrahi tedavisini birbiri ile karşılaştıran randomize kontrollü çalışmalar olmadığı için cerrahi tedavi modalitelerinin semptomlarda klinik düzelme, komplikasyonlar, rekürrens ve gebelik oranları üzerine etkisi bilinememektedir. Güncel literatüre göre, barsak oklüzyonu ve/ veya rektal kanama olmadan mukozal tutulum olan DİE vakaları invazif bir teknik olan barsak rezeksiyonu ve anastomozundan daha düşük komplikasyon ve rekürrens oranlarına sahip olduğundan dolayı özel olarak “traşlama” adı verilen konservatif bir teknikle tedavi edilmelidirler.

Anahtar sözcükler: Laparoskopi, gastrointestinal, rektovajinal, barsak endmetriozisi, cerrahi tedavi

References

  • Donnez J, Nisolle M, Smoes P, Gillet N, Beguin S, Casanas-Roux F. Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities. Fertil Steril 1996; 66: 362-8.
  • Squifflet J, Feger C, Donnez J. Diagnosis and imaging of adenomyotic disease of the retroperitoneal space. Gynecol Obstet Invest 2002; 54: 43-51.
  • Fuller J, Ashar BS, Carey-Corrado J. Trocar associated injuries and fatalities: An analysis of 1399 reports to the FDA. J Minim Invasive Gynecol 2005; 12: 302-7. De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: A systematic review. BJOG 2011: 285-91.
  • Weed JC, Ray JE. Endometriosis of the bowel. Obstet Gynecol 1987; 69: 727-30. Redwine DB. Ovarian endometriosis: A marker for more extensive pelvic and intestinal disease. Fertil Steril 1999; 72: 310-5.
  • Bailey HR, Ott MT, Hartendorp P. Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 1994; 37: 747-53.
  • Pereira RM, Zanatta A, Preti CD, de Paula FJ, da Motta EL, Serafini PC. Should the gynecologist perform laparoscopic bowel resection to treat endometriosis? Results over 7 years in 168 patients. J Minim Invasive Gynecol 2009; 16: 472-9. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68: 585-96.
  • Anaf V, Simon P, El Nakadi I, Fayt I, Simonart T, Buxant F, Noel JC. Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod 2002; 17: 1895-900.
  • Wills HJ, Reid GD, Cooper MJ, Morgan M. Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: A review. Aust N Z J Obstet Gynaecol 2008; 48: 292-5.
  • Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A. Deeply infiltrating endometriosis: Pathogenetic implications of the anatomical distribution. Hum Reprod 2006; 21: 1839-45.
  • Hartmann D, Schilling D, Roth SU, Bohrer MH, Riemann JF. [Endometriosis of the transverse colon--a rare localization]. Dtsch Med Wochenschr 2002; 127: 2317Meuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D'Hooghe T. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 2011; 17: 311-26.
  • Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: A pilot study. Hum Reprod 2010; 25: 94-100.
  • Reich H, McGlynn F, Salvat J. Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis. J Reprod Med 1991; 36: 516Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: A series of 500 cases. Br J Obstet Gynaecol 1997; 104: 1014-8.
  • Donnez J, Squifflet J. Laparoscopic excision of deep endometriosis. Obstet Gynecol Clin North Am 2004; 31: 567-80.
  • Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005; 12: 508-13.
  • Donnez J, Nisolle M, Squifflet J. Endoscopic management of peritoneal and ovarian endometriosis. In Donnez J, Nisolle M, eds. An atlas of Operative Laparoscopy and Hysteroscopy, 2nd edn. Carnforth, UK: Parthenon Publishing 2001: 69-76.
  • Kavallaris A, Köhler C, Kühne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod 2003; 18: 1323-7.
  • Roman H, Loisel C, Resch B, Tuech JJ, Hochain P, Leroi AM, Marpeau L. Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: Giving patients an informed choice. Hum Reprod 2010; 25: 890-9.
  • Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: The other side of the story. Hum Reprod Update 2009; 15: 177-88.

Gastrointestinal tutulum olan ileri evre ve rektovajinal endometriozisin laparoskopik yönetimi: Güncel literatürün bir derlemesi

Year 2014, Volume: 36 Issue: 2, 281 - 287, 27.06.2014
https://doi.org/10.7197/cmj.v36i2.1008002531

Abstract

Endometriozis iyi huylu bir hastalık prosesi olmasına rağmen endometrial gland ve stromanın uterus dışında potansiyel olarak invazif bir davranışla bulunmasıdır. Hastalığın kesin prevelansı bilinmemektedir fakat üreme çaındaki kadınların yaklaşık %10-15’i etkilenmiştir. Peritoneal ve rektovajinal endometriozis hastalığın farklı semptom ve tedavi stratejileri olan iki ayrı antitesidir. Rektovajinal muayene sırasında sakrouterin ligamentlerde nodülarite ile beraber diskezi ve derin disparanü derin infiltratif endometriozisin (DİE) spesifik semptomlarıdır. Endometriozisli hastaların yaklaşık %5-12’sinde rektovajinal veya barsak tutulumu mevcut olduğu tahmin edilmektedir ve en sık tutulan bölge rektosigmoid kolondur. Kolorektal tutumlu DİE’nin tıbbi tedavisi endometriotik odaklar üzerinde herhangi bir küratif etki etmeden semptomatik rahatlama sağlar. Tanısal bir laparoskopi sırasında tesadüfen saptandığında kolorektal endometriozis tedavisi klinisyenler için major bir sorundur. Rektovajinal veya barsak endometriozisinin medikal ve cerrahi tedavisini birbiri ile karşılaştıran randomize kontrollü çalışmalar olmadığı için cerrahi tedavi modalitelerinin semptomlarda klinik düzelme, komplikasyonlar, rekürrens ve gebelik oranları üzerine etkisi bilinememektedir. Güncel literatüre göre, barsak oklüzyonu ve/ veya rektal kanama olmadan mukozal tutulum olan DİE vakaları invazif bir teknik olan barsak rezeksiyonu ve anastomozundan daha düşük komplikasyon ve rekürrens oranlarına sahip olduğundan dolayı özel olarak “traşlama” adı verilen konservatif bir teknikle tedavi edilmelidirler.

References

  • Donnez J, Nisolle M, Smoes P, Gillet N, Beguin S, Casanas-Roux F. Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities. Fertil Steril 1996; 66: 362-8.
  • Squifflet J, Feger C, Donnez J. Diagnosis and imaging of adenomyotic disease of the retroperitoneal space. Gynecol Obstet Invest 2002; 54: 43-51.
  • Fuller J, Ashar BS, Carey-Corrado J. Trocar associated injuries and fatalities: An analysis of 1399 reports to the FDA. J Minim Invasive Gynecol 2005; 12: 302-7. De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: A systematic review. BJOG 2011: 285-91.
  • Weed JC, Ray JE. Endometriosis of the bowel. Obstet Gynecol 1987; 69: 727-30. Redwine DB. Ovarian endometriosis: A marker for more extensive pelvic and intestinal disease. Fertil Steril 1999; 72: 310-5.
  • Bailey HR, Ott MT, Hartendorp P. Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 1994; 37: 747-53.
  • Pereira RM, Zanatta A, Preti CD, de Paula FJ, da Motta EL, Serafini PC. Should the gynecologist perform laparoscopic bowel resection to treat endometriosis? Results over 7 years in 168 patients. J Minim Invasive Gynecol 2009; 16: 472-9. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68: 585-96.
  • Anaf V, Simon P, El Nakadi I, Fayt I, Simonart T, Buxant F, Noel JC. Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod 2002; 17: 1895-900.
  • Wills HJ, Reid GD, Cooper MJ, Morgan M. Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: A review. Aust N Z J Obstet Gynaecol 2008; 48: 292-5.
  • Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A. Deeply infiltrating endometriosis: Pathogenetic implications of the anatomical distribution. Hum Reprod 2006; 21: 1839-45.
  • Hartmann D, Schilling D, Roth SU, Bohrer MH, Riemann JF. [Endometriosis of the transverse colon--a rare localization]. Dtsch Med Wochenschr 2002; 127: 2317Meuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D'Hooghe T. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 2011; 17: 311-26.
  • Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: A pilot study. Hum Reprod 2010; 25: 94-100.
  • Reich H, McGlynn F, Salvat J. Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis. J Reprod Med 1991; 36: 516Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: A series of 500 cases. Br J Obstet Gynaecol 1997; 104: 1014-8.
  • Donnez J, Squifflet J. Laparoscopic excision of deep endometriosis. Obstet Gynecol Clin North Am 2004; 31: 567-80.
  • Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005; 12: 508-13.
  • Donnez J, Nisolle M, Squifflet J. Endoscopic management of peritoneal and ovarian endometriosis. In Donnez J, Nisolle M, eds. An atlas of Operative Laparoscopy and Hysteroscopy, 2nd edn. Carnforth, UK: Parthenon Publishing 2001: 69-76.
  • Kavallaris A, Köhler C, Kühne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod 2003; 18: 1323-7.
  • Roman H, Loisel C, Resch B, Tuech JJ, Hochain P, Leroi AM, Marpeau L. Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: Giving patients an informed choice. Hum Reprod 2010; 25: 890-9.
  • Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: The other side of the story. Hum Reprod Update 2009; 15: 177-88.
There are 18 citations in total.

Details

Primary Language English
Journal Section Reviews
Authors

Serkan Kahyaoğlu

Publication Date June 27, 2014
Published in Issue Year 2014Volume: 36 Issue: 2

Cite

AMA Kahyaoğlu S. Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature. CMJ. June 2014;36(2):281-287. doi:10.7197/cmj.v36i2.1008002531