Hilgers, T. W. (2004). Chapter 72: PEARS for Bowel Endometriosis: Surgical Techniques for the General Surgeon. In The Medical and Surgical Practice of NaProTECHNOLOGY (pp. 975-1000).
Hilgers TW. Chapter 72: PEARS for Bowel Endometriosis: Surgical Techniques for the General Surgeon. In: The Medical and Surgical Practice of NaProTECHNOLOGY. 2004. p. 975-1000.
Hilgers, T. W. "Chapter 72: PEARS for Bowel Endometriosis: Surgical Techniques for the General Surgeon." The Medical and Surgical Practice of NaProTECHNOLOGY, 2004, pp. 975-1000.
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RRM Academy Synopsis
Complex bowel endometriosis calls for a general or colorectal surgeon
A 2004 surgery textbook chapter says a gynecologic surgeon should bring in a general or colorectal surgeon when bowel endometriosis may need resection. The chapter shows how to remove and repair lesions on the small bowel, colon and rectum.
Key Findings
Small bowel endometriosis most often sits on the terminal ileum, sometimes at the ileocecal valve, and can cause partial obstruction symptoms such as gas pains and fullness after eating.
Rectosigmoid lesions are often superficial but can be multiple. The chapter says that when one lesion is found, others should be looked for.
Anterior rectum lesions are often more penetrating, especially with an obliterated cul-de-sac. The chapter says slowly freeing the rectal wall from the cervix and vagina lets the lesion be identified.
The chapter describes excising nodules with repair of the bowel wall, and segmental bowel resection with reanastomosis when lesions are extensive or narrow the bowel.
Coronado and colleagues, cited in the chapter, reported satisfactory pain relief after anterior wall colon resection by laparotomy for deeply infiltrating lower colorectal endometriosis.
Interpretation
This chapter treats bowel endometriosis as disease to remove completely. Excision of nodules and segmental resection with reanastomosis both aim to take the lesion out whole, matching the complete-excision standard used elsewhere in the body. The pain relief that Coronado and colleagues reported after colon resection for deep disease supports this approach for the bowel. A surgeon who spots a fixed, multiply nodular, or penetrating lesion during workup can plan ahead for a general or colorectal surgeon before the case starts. Wider surgical case series on bowel resection would help confirm how often that pain relief holds.
RRM Context
The chapter sits inside a NaProTECHNOLOGY surgical textbook. PEARS surgery aims at complete excision of endometriosis, and bowel lesions are among the hardest sites to reach. Leaving them behind leaves disease in place. For that reason, the chapter treats bowel involvement as part of complete excision and calls for a general or colorectal surgeon on complex cases. The staffing model and surgical sequence described here belong to NaProTECHNOLOGY specifically.
Our editorial summary of this paper, not the article's abstract.
Abstract
This chapter details the more complex surgical procedures for endometriosis of the small bowel, rectosigmoid colon and anterior rectum, for which it recommends involving a general or colorectal surgeon as part of the care team. The chapter reviews the anatomy and blood supply of the ileocecal region, colon and rectum, and describes excision of non-constricting nodules of the terminal ileum, hand-sewn and stapled small bowel anastomosis, and a three-layer closure of the anterior rectum after a penetrating nodule is excised. For extensive anterior rectal lesions causing stricture of the bowel lumen, the chapter describes resection of the rectosigmoid colon with stapled reanastomosis, illustrated with operative photographs. The chapter also describes melanosis coli and outlines postoperative care, noting that the hospital stay is prolonged when the bowel is entered because the bowel takes longer to recuperate.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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