Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum

Background. Two aims: 1)Tc, assess the results of laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal sep tum (RVS): 2) to pinpoint the differences between this procedure and that u sed for deep endometriotic lesions located on the uterosacral ligaments (US L). Methods. Descriptive retrospective study. Twenty-nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series. Results. One patient only (3.5%) presented a major complication of the rect o-vaginal fistula type. After a one step reoperation under anesthesia, the post operative history was uncomplicated and no sequelae are to be deplored . With respect to dysmenorrhea (DM), deep dyspa reunia (DP) and chronic pel vic pain (CPP), there was an improvement in respectively 91.7% (22 patients ), 100% (24 patients) and 92.9% (13 patients) of cases. For each of these 3 symptoms the median score according to the visual analog scale was signifi cantly lower after the operation (for DM: 7.6 +/-2.0 versus 1.7 +/-2.6; for DP 7.5 +/-1.9 versus 0.5 +/-1.1; for CPP 5.9 +/-2.8 versus 1.4+3.2) (p<0.0 001). Conclusions. These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatmen t of patients presenting painful symptoms related to deep endometriotic inf iltrating the RVS. From the technical point of view the rectum must be free d, leaving the deep endometriotic nodule attached to the posterior wall of the vagina. Resection of the whole lesion requires the posterior wall of th e vagina to be resected, whereas ureterolysis is often unnecessary So for l esions located on the RVS the vagina is opened systematically, unlike the s ituation when resecting deep endometriotic lesions infiltrating the USL. De ep pelvic endometriosis is not synonymous with endometriosis of the RVS. Le sions truly infiltrating the RVS represent only a small proportion of all J eep endometriosis lesions.