Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection.

Objective. To evaluate symptom relief following a laparoscopic technique de signed for treatment of complete obliteration of the cul-de-sac associated with endometriosis, with fertility preserved. Design: Preoperative and postoperative questionnaire study of a cohort of p atients with complete obliteration of the cul-de-sac undergoing a standardi zed laparoscopic. surgical treatment. Setting: American tertiary referral center for the surgical treatment of en dometriosis. Patients: Eighty-four consecutive patients undergoing laparoscopic treatmen t of endometriosis with complete cul-de-sac obliteration with 67 replying t o a postoperative questionnaire. Interventions: Laparoscopic excision of all endometriosis including treatme nt of complete obliteration of the cul-de-sac by en bloc resection and bowe l resection as needed. Main Outcome Measures: Symptom relief as measured on a 5-point ranked ordin al scale administered before and after surgery, as well as perioperative co mplications, postoperative fertility, and prognostic value of preoperative findings on pelvic examination. Results: Symptom reduction was obtained for all symptoms related to cul-de- sac disease, particularly for patients with severe or debilitating symptoms preoperatively. There was no significant complication, and the postoperati ve fertility rate was 43%. Seventy-three percent of patients with obliterat ion of the cul-de-sac had histologically proved rectal endometriosis. Nodul arity and tenderness on examination were predictive of symptom improvement. Conclusions: Aggressive laparoscopic excision of endometriosis carried out in a specialist center offers good symptom relief, especially for those wit h severe or debilitating symptoms. To ensure complete removal of all diseas e, intestinal surgery is required in most patients with complete obliterati on of the cul-de-sac. (C) 2001 by American Society for Reproductive Medicin e.