Shaving for Bowel Endometriosis

Abstract

Study Objective: To demonstrate laparoscopic shaving of deeply infiltrative endometriosis affecting the rectosigmoid colon, with particular emphasis on the anatomic and technical aspects of the procedure. Design: Stepwise demonstration of the technique with narrated video footage. Setting: Intestinal involvement in deep endometriosis is estimated to occur in 8% to 12% of patients, with 90% of occurrences being located in the colorectal segment. Deep endometriosis of the rectosigmoid is defined as endometriosis involving the muscular layer of the bowel wall, usually >5 mm deep, thus excluding superficial lesions that only affect the serosal layer. In cases in which medical therapy is unsatisfactory, rectosigmoid deep endometriosis can be surgically managed by 3 recognized surgical techniques: (1) rectal shaving, (2) disc excision, and (3) segmental resection. There are helpful recommendations for different approaches on the basis of the characteristics of the lesion, including the size, length, depth of invasion, involved rectal circumference, and number of lesions, among other factors [1]. Rectal shaving is well suited for smaller lesions, typically <3 cm, and involves "shaving" the lesion in the affected muscular layer of the bowel wall off the mucosa, ideally without entering the bowel lumen. It is associated with lower rates of perioperative complications and lower probability of long-term postoperative bladder and bowel dysfunctions [2]. Interventions: This video demonstrates and highlights the anatomic and technical aspects of the following important steps of the rectal shaving procedure: (1) suspension of ovaries; (2) mobilization of the diseased segment of the rectum; (3) shaving of the lesions, with pertinent comments at different stages of nodule excision; (4) checking for the integrity of the bowel wall; and (5) suture of the muscularis defect after excision of the lesions from the muscularis layer of the bowel. Conclusion: Compared with other alternatives, shaving for bowel endometriosis is a more conservative procedure with lower rates of perioperative complications, and it is less likely to result in long-term bladder and bowel dysfunctions. Therefore, shaving is preferable and recommended for appropriate lesions.

Regarding “Rectal Shaving for Bowel Endometriosis by a Laparoscopic Reverse Submucosal Dissection: Points to be Highlighted”

“…The proposed method may also play a role in reducing the number of patients undergoing a segmental bowel resection. We agree with all these aspects, and despite this modification requiring further evaluation, as mentioned by the authors, it is a very promising technique and improves the surgical management of deep endometriosis (DE) with rectal involvement (2). DE is the most severe type of endometriosis, and it affects the bowel in up to 25% of cases and is frequently associated with dyspareunia, dysmenorrhea, and a reduced quality of life (3,4).…”

Targeted Ultrasound for Deep Bowel Endometriosis

“…Bowel endometriosis is a complex gynecologic condition that requires targeted investigation and multi-disciplinary care by an experienced team 1 . Here, we demonstrate the value of the pre-operative transvaginal sonography in the assessment of deep endometriosis involving the bowel.…”

Laparoscopic shaving for colorectal endometriosis: a literature review

“…Rectal shaving is well suited for smaller lesion (typically <3 cm) without entering the bowel lumen. 2 Recently, Donnez and Roman concluded that surgeons should consider rectal shaving as first-line surgical treatment of deep endometriosis, irrespective of nodule size or association with other digestive sites. 3,4 The goal of this paper is to review the available literature on shaving technique in terms of complications and recurrence comparing it with other techniques.…”