TECHNICAL ASPECTS OF MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF ENDOMETRIOSIS INVOLVING THE RECTUM

Introduction Endometriosis is a chronic disease defined as the presence of endometrial tissue outside the uterus. Involvement of the colon and rectum can occur in up to 10% of women, primarily in the rectosigmoid region. In cases where clinical treatment is refractory, surgical treatment may be indicated and can involve resection of the affected organs to achieve adequate disease control.

Objectives To surgically describe a minimally invasive approach to endometriosis with massive invasion of the rectum, where a totally laparoscopic colorectal anastomosis was performed.

Methods A 37-year-old patient presented with complaints of colicky abdominal pain worsening during menstruation, as well as stool thinning, tenesmus, and constipation. Digital rectal examination revealed a hardened lesion in the rectum, and MRI showed endometriotic foci in the uterosacral ligament and rectum, along with significant adenomyosis. With a defined parity, surgery was opted for, involving hysterectomy combined with rectosigmoidectomy to control the symptoms.

Results A standard laparoscopic rectosigmoidectomy combined with hysterectomy was performed, with vaginal extraction of the surgical specimen. A circular stapler head was introduced via the vaginal route, and a totally laparoscopic colorectal anastomosis was successfully completed. The patient experienced excellent outcomes, with complete resolution of her symptoms.

Conclusion A totally laparoscopic approach with vaginal specimen extraction in cases of benign disease can be successfully performed, offering the benefit of avoiding abdominal incisions.

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Artikel online veröffentlicht:
25. April 2025