Laparoscopic management of colorectal endometriosis

Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery. The purpose of t his study was to describe the laparoscopic management of colorectal endomet riosis at a tertiary referral center. Methods: From November 1994 to March 1998, 509 consecutive patients with en dometriosis requiring laparoscopic intervention were prospectively evaluate d. Those with colorectal involvement were analyzed for stage of disease, pr ocedure, operative time, conversion rate, length of hospitalization, and co mplications. Results: In 30 of the 509 patients (5.9%), colorectal involvement was ident ified. Twenty-eight of these 30 had stage IV disease. Intestinal involvemen t was suspected preoperatively in 13 of 30. Twelve required superficial exc ision of colon or rectal endometriomas. Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patient s. Four cases required conversion due to the overall severity of the pelvic disease. For those who did(n = 12) and did not (n = 18) require full-thick ness excisions/resections, the median operative time was 180 min (range, 90 -390) and 110 min (range, 45-355), respectively; the median length of hospi talization was 4 days (range, 3-7) and 1 day (range, 0-4), respectively. A major complication occurred in one patient (colovaginal fistula). At a medi an follow-up of 10 months (range 1-32), 28 patients were improved, and 24 o f these had near or total resolution of preoperative symptoms. Conclusions: Extensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic treatment of c olorectal endometriosis, even in advanced stages, is safe, feasible, and ef fective in nearly all patients.