Laparoscopic en bloc resection for treatment of the obliterated cul-de-sac in endometriosis

Bowel Invisible Microscopic Endometriosis: Leave It Alone

Redwine DB et al., 2018 · Journal of minimally invasive gynecology

Dissecting and temporarily resuspending the adherent ovary

Redwine DB, 2006 · Fertility and sterility

Complications of laparoscopic surgery: How to avoid them and how to repair them

Shirk GJ et al., 2006 · Journal of minimally invasive gynecology

Variations in tubal configuration in endometriosis?

Redwine DB, 2006 · Fertility and sterility

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

Redwine DB et al., 2001 · Fertility and sterility

To evaluate symptom relief following a laparoscopic technique designed for treatment of complete obliteration of the cul-de-sac associated with endometriosis, with fertility preserved. Preoperative and postoperative questionnaire study of a cohort of patients with complete obliteration of the cul-de-sac undergoing a standardized laparoscopic surgical treatment. American tertiary referral center for the surgical treatment of endometriosis. Eighty-four consecutive patients undergoing laparoscopic treatment of endometriosis with complete cul-de-sac obliteration with 67 replying to a postoperative questionnaire. Laparoscopic excision of all endometriosis including treatment of complete obliteration of the cul-de-sac by en bloc resection and bowel resection as needed. Symptom relief as measured on a 5-point ranked ordinal scale administered before and after surgery, as well as perioperative complications, postoperative fertility, and prognostic value of preoperative findings on pelvic examination. 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 postoperative fertility rate was 43%. Seventy-three percent of patients with obliteration of the cul-de-sac had histologically proved rectal endometriosis. Nodularity and tenderness on examination were predictive of symptom improvement. Aggressive laparoscopic excision of endometriosis carried out in a specialist center offers good symptom relief, especially for those with severe or debilitating symptoms. To ensure complete removal of all disease, intestinal surgery is required in most patients with complete obliteration of the cul-de-sac.

Aggressive laparoscopic excision of endometriosis of the cul-de-sac and uterosacral ligaments

Redwine DB, 1997 · The Journal of the American Association of Gynecologic Laparoscopists

Retroperitoneal endometriosis infiltrating the utero-sacral ligaments. Technique and results of laparoscopic surgery

Chapron C et al., 1997 · J Gynecol Obstet Biol Reprod (Paris)

The goal of this study is to assess the efficiency of laparoscopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. We analysed a continuous series of 36 patients treated by operative laparoscopy between January 1993 and April 1995. In all these cases treatment consisted of resection of all the uterosacral ligament(s) together with exeresis of all other endometriotic lesions. The results were assessed for all the patients with a minimum follow-up of one year. Patients who presented dysmenorrhea (29 cases) improved in 89.7% of cases (26 patients). Out of the 26 patients who presented deep dyspareunia, improvement was evident for 92.3% of cases (24 patients). The chronic pelvic pain suffered (17 cases) improved in 88.2% of cases (15 patients). Patients who benefited from an improvement rated it excellent or satisfactory in 80% of cases. These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic implants located on the uterosacral ligaments.

Laparoscopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis

Sharpe DR et al., 1992 · Surgical laparoscopy & endoscopy

Patients with symptomatic endometriosis of the colon and distal small bowel usually present with crampy abdominal pain, pelvic and rectal pain, constipation, and dyspareunia. Superficial disease can be easily resected laparoscopically with scissors. Deeper lesions require full-thickness resection and closure of the bowel. Occasionally deep, large, or multiple lesions will require segmental resection for adequate control of the disease. Five patients with intestinal endometriosis underwent attempted laparoscopic segmental colon resection. Two patients required conversion to open laparotomy because of difficulty with the anastomosis. No operative complications or deaths occurred in this group. Those patients undergoing laparoscopic colectomy showed return of bowel function within 24 to 48 h and were discharged home on postoperative day 4.