Laparoscopic surgery for colorectal endometriosis: An Australian series of 307 cases — YRD
  1. Schedule
  2. Session 3: Free Communication Session A
  3. Laparoscopic surgery for colorectal endometriosis: An Australian series of 307 cases

Laparoscopic surgery for colorectal endometriosis: An Australian series of 307 cases (#A6)

Hannah J Wills 1 , Jim Tsaltas 2 , Michael Cooper 3 , Geoffrey Reid 4 , Matthew Morgan 5 , Rod Woods 6
  1. Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
  2. Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
  3. Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, Australia
  4. Department of Women's and Child Health, Liverpool Hospital, Sydney, NSW, Australia
  5. Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  6. Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia

INTRODUCTION: Colorectal involvement is estimated to occur in up to 12% of cases of endometriosis.1 Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the surgical experiences of three Australian gynaecologists to consider the effect of laparoscopic bowel surgery for colorectal endometriosis.

METHODS: The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or anterior segmental resection between 1999 and 2012. Surgery was performed as described in an existing series.2

RESULTS: A total of 307 patients were identified. The average patient age at the time of surgery was 34.8 years (range 18-51). Amongst these, 192 women (62.5%) presented with pelvic pain or dysmenorrhoea as their primary complaint, 27 (8.8%) with infertility, and 80 (26.1%) with pain and infertility. Information was unavailable for 4 patients (1.3%). A further 4 patients presented for other reasons.

Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy, equating to a conversion rate of 7.5%. Two hundred and sixty-five procedures to remove additional sites of endometriosis were performed concurrently with bowel surgery. A further 77 procedures, not primarily for endometriosis, were also conducted.

Complications occurred in 35 of the 307 cases, equating to a complication rate of 11.4%. Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy, equating to a pregnancy rate of 54.9%. Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through IVF or ICSI, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%).

CONCLUSIONS: The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility. Research into the optimal management of this clinically-challenging condition must continue, with a particular focus upon surgical complications and fertility outcomes.

  1. Darai E, Bazot M, Rouzier S, et al. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol 2007; 19:308-13.
  2. Wills H, Reid G, Cooper M , et al. Bowel resection for severe endometriosis: an Australian series of 177 cases. ANZJOG. 2009; 49: 415-8.