Laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis

Objectives To confirm the feasibility and safety of laparoscopically assist ed segmental sigmoid resection (LASSR) for sigmoid endometriosis. Setting Gynaecology and surgery departments at a university hospital. Subjects Between August 1997 and April 1999, five patients with symptomatic sigmoid endometriosis and concomitant pelvic endometriosis underwent LASSR . During that same period laparoscopic procedures for endometriosis involvi ng the intestinal tract included: five anterior resections of the rectum wi th transanal end-to-end anastomosis for extensive rectosigmoid endometriosi s, 26 resections of rectovaginal endometriotic nodules and one appendectomy . Interventions These included: laparoscopic dissection of the left large bow el from its adherent neighbouring structures, incision of the lateral and m edial peritoneal reflections of the mesosigmoid, incision of the left parac olic gutter, identification of the left ovarian vessels and left ureter, ex tracorporeal resection of the sigmoid and lateroterminal handsewn anastomos is, and laparoscopic treatment of concomitant pelvic endometriosis. Results Neither intra- nor postoperative complications occurred. The mean o perating time was 210 min. Postoperative ileus lasted less than 72 h in all cases (n = 5). The mean postoperative hospital stay was 6 days. There was no recurrence of sigmoid endometriosis symptoms over follow up for a mean o f 15.2 months. Conclusions LASSR is a feasible and safe technique which is indicated for s ymptomatic sigmoid endometriosis. It allows the simultaneous laparoscopic m anagement of pelvic endometriosis. Better cosmesis is an immediately recogn izable benefit of this technique. Reduced postoperative pain and shortened postoperative ileus represent presumed advantages of LASSR compared with op en surgery. The use of LASSR can help to reduce the cost of the laparoscopi c instrumentation that is necessary for total laparoscopic colectomy.