LAPAROSCOPIC DISK EXCISION AND PRIMARY REPAIR OF THE ANTERIOR RECTAL WALL FOR THE TREATMENT OF FULL-THICKNESS BOWEL ENDOMETRIOSIS

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29-38, with extensive sym ptomatic pelvic endometriosis were included in this series. All were d iagnosed as having severe pelvic endometriosis and had not responded t o previous conservative surgical and hormonal therapy. In a 5-18-month postoperative followup, six women have reported complete relief of th e symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two h ave accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed comple tely with filmy adhesions between the posterior aspect of the uterus a nd the rectosigmoid colon in one patient. The second woman had undergo ne extensive adhesiolysis at the first surgery, and these adhesions re curred; however, the anastomotic site had healed completely. One of th e two infertility patients has achieved pregnancy. The only complicati on was one patient with ecchymosis of the anterior abdominal wall. Sig moidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic si tes have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.