Surgery: Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients

Abstract

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.

Urological and colorectal complications following surgery for rectovaginal endometriosis

“…This probably reflects the fact the number of cases of severe disease that we are being referred is increasing. Marpeau et al 21 15.6 6.3 Darai et al 22 17.5 7.5 Camagna et al 23 6.9 Ford et al 11 1.6 Donnez et al 24 0.9 Fedele et al 10 3.6 Landi et al 25 6.6 Koninckx et al 18 3.1 …”

Colorectal endometriosis and fertility

“…For example, Donnez et al [24] defined shaving as a separation of the anterior from the posterior vagina, an excision or ablation of DIE after complete dissection of the nodule from the posterior part of the cervix, systematically removing the posterior vaginal fornix while Meuleman et al [18] defined rectal shaving as superficial peeling of bowel serosal and subserosal endometriosis. Six studies assessed the impact of surgery on fertility outcomes in women with RVS endometriosis [24][25][26][27][28][29] but none of them distinguished between women with and without colorectal endometriosis. These six studies were thus excluded from the present review.…”

Surgical treatment of rectovaginal endometriosis with rectal involvement

“…Initially, the majority of papers defended a conservative surgical approach directed toward the extirpation or ablation of the endometriosic lesions with minimal excisional surgery of the rectum [6,12,[65][66][67][68]. However, in the last decade, multiple authors have proposed more aggressive techniques including intestinal resection, especially in those cases with an affected muscularis propia of the rectum but also in those having an intact mucosa [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”