Deep endometriosis: The place of laparoscopic shaving. (March 2021)

• Record Type: Journal Article
• Authors: Donnez, Olivier; Donnez, Jacques
• Is Part Of: Best practice & research. Volume 71(2021)
• Page Start: 100
• Page End: 113
• Publication Date: 2021-03
• Subjects: Deep endometriosis -- Surgery -- Shaving -- Surgical outcomes -- Complications -- Recurrence; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2020.05.006
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: Deep endometriosis (DE) is considered to be one of the most challenging conditions to manage, especially when it invades surrounding organs like the rectum. Surgical excision of deep rectovaginal endometriosis is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions, or if they evolve. Preoperative radiological examination should be extensive to determine the appropriate surgery: laparoscopic shaving, disc excision, or rectal resection. We demonstrated that in the hands of experienced surgeons, rectal shaving is possible for DE in more than 95% of cases, with low complication rates compared to rectal resection. Shaving and bowel resection are associated with comparable recurrence rates. As shaving is indicated whatever the size of deep lesions, surgeons should first consider rectal shaving to remove DE. Bowel resection should only be performed in case of major rectal stenosis (>80%), multiple and/or posterior rectal lesions and stenotic sigmoid colon lesions. Highlights: In the hands of experienced surgeons, rectal shaving is possible for deep endometriosis in more than 95% of cases. Shaving is indicated whatever the size of deep lesions. Shaving shows low complication rates, especially in terms of rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Shaving and bowel resection are associated with comparable recurrence rates. Indication of bowel resection are >80% rectal stenosis, multiple or posterior rectal lesions, and stenotic sigmoid lesions.