ABSTRACT: Surgical treatment of females with rectal endometriosis is challenging. The aim of this study was to review the results of laparoscopic intervention in the management of females with this complex disorder.
All cases of complex tertiary referral pelvic endometriosis requiring laparoscopic surgical intervention of the rectum were identified and reviewed from a prospective database.
Between April 1996 and August 2004, 95 patients with pelvic endometriosis involving the rectum had laparoscopic surgical procedures performed by one gynecologist and one colorectal surgeon. Eighty percent of rectal procedures were completed laparoscopically. Forty-three (45 percent) were treated with diathermy excision, 18 (19 percent) had shave partial-thickness disc excision, 20 (21 percent) had full-thickness disc excision (including 14 endoanally using a circular stapler), while 14 (15 percent) were managed with laparoscopic-assisted segmental low anterior resection. A history of rectal pain during defecation present only during menstruation (adjusted odds ratio=8.6, 95 percent confidence interval (CI)=1.8-41.2) and previous laparoscopy (adjusted odds ratio=3.2, 95 percent CI=1.2-8.3) independently predicted a need for more extensive surgery than diathermy excision. There were no rectal anastomotic leaks, with 8 percent overall morbidity. The only significant predictor of ongoing postoperative symptoms was a history of dyspareunia (P=0.03).
Patients with complex endometriosis of the rectum can be safely managed laparoscopically using a multidisciplinary approach. This case series suggests that a history of rectal pain during defecation that occurs only during menstruation is predictive of females with more extensive rectal disease.
Diseases of the Colon & Rectum 03/2006; 49(2):169-74. · 3.13 Impact Factor
ANZ Journal of Surgery 10/2004; 74(9):809-10. · 1.25 Impact Factor
ABSTRACT: Various treatment measures have been described in achieving splenic preservation following splenic injury. We describe an additional measure in achieving haemostasis during mesh splenorrhaphy.
Oxycel (BD, Franklin Lakes, NJ, USA) (topical haemostatic agent composed of oxidized cellulose) is sutured onto the inside of Dexon (Sherwood, Davis & Geck, St Louis, MO, USA) (polyglycolic acid) mesh.
Two patients with splenic lacerations were operated on from July 2002 to February 2003 using this technique and both patients did not experience postoperative abdominal complications and were clinically well at follow up 1-2 months later.
In our experience this technique made the Dexon mesh bulkier and easier to secure as well as more haemostatic.
ANZ Journal of Surgery 07/2004; 74(7):596-7. · 1.25 Impact Factor
ANZ Journal of Surgery 09/2002; 72(8):601-3. · 1.25 Impact Factor