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LAPAROSCOPICALLY ASSISTED VAGINAL RESECTION OF RECTOVAGINAL ENDOMETRIOSIS

From the Department of Gynecology, Friedrich Schiller University, Jena, Germany.

Address reprint requests to: Achim Schneider, MD, MPH Department of Gynecology Friedrich Schiller University Bachstrasse 18 07740 Jena Germany E-mail: achim.schneider{at}med.uni-jena.de

Background: We wanted to establish a technique of laparoscopically assisted radical vaginal surgery for deep endometriosis of the rectovaginal septum with extensive rectal involvement.

Technique: The procedure is started by vaginally excising the involved area which is left on the rectum, followed by bilateral dissection of the pararectal and retrorectal spaces. Para- and retrosigmoido-rectal spaces are developed laparoscopically along the coccygeosacral bone and medially to the pelvic splanchnic nerves toward the para- and retrorectal openings that were made transvaginally. Rectal transection is done with a laparoscopic stapling device caudal to the endometriotic lesion. Using a suprapubic minilaparotomy, the bowel is transected cranial to the lesion and reintroduced into the abdomen, and a transanal circular stapler anastomosis is done.

Experience: Thirty-four women had this procedure. The mean distance of the anastomosis was 4 cm above the anus. None required ileostomy or colostomy and no major complications were noted.

Conclusion: The combination of laparoscopic and vaginal approaches is useful for removing extensive endometriotic infiltration of the rectosigmoid; bladder and rectal function and fertility can be preserved.

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