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Best Pract Res Clin Obstet Gynaecol. 2019 Jan 29. pii: S1521-6934(18)30241-4. doi: 10.1016/j.bpobgyn.2019.01.010. [Epub ahead of print]

Choosing the right technique for deep endometriosis.

Author information

1
Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Boulevard du 12eme de Ligne,1, 4000, Liège, Belgium. Electronic address: michelle.nisolle@uliege.be.
2
Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Boulevard du 12eme de Ligne,1, 4000, Liège, Belgium. Electronic address: gbrichant@chuliege.be.
3
Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Boulevard du 12eme de Ligne,1, 4000, Liège, Belgium. Electronic address: Linda.tebache@chrcitadelle.be.

Abstract

The surgical management of bowel endometriosis is a real challenge. In addition to the fact that only symptomatic patients should undergo surgery, no consensus has been approved in the literature. Among the surgical techniques, the surgeon has to choose between rectal shaving, disc excision, or segmental colorectal resection. All those procedures are associated with complications, but the risk of rectovaginal fistula is higher if a disc excision or segmental colorectal resection is performed. It is therefore of utmost importance to evaluate preoperatively the bowel infiltration by several imaging techniques to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions or to discuss with the patient about the indication of a segmental bowel resection. Because of the risk of major preoperative and postoperative complications, proper patient counseling is mandatory.

KEYWORDS:

Deep endometriosis; Disc excision; Rectal shaving; Segmental rectal resection

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