Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature

Endometriozis iyi huylu bir hastalık prosesi olmasına rağmen endometrial gland ve stromanınuterus dışında potansiyel olarak invazif bir davranışla bulunmasıdır. Hastalığın kesin prevelansıbilinmemektedir fakat üreme çaındaki kadınların yaklaşık %10-15i etkilenmiştir. Peritoneal verektovajinal endometriozis hastalığın farklı semptom ve tedavi stratejileri olan iki ayrı antitesidir.Rektovajinal muayene sırasında sakrouterin ligamentlerde nodülarite ile beraber diskezi ve derindisparanü derin infiltratif endometriozisin (DİE) spesifik semptomlarıdır. Endometriozislihastaların yaklaşık %5-12sinde rektovajinal veya barsak tutulumu mevcut olduğu tahminedilmektedir ve en sık tutulan bölge rektosigmoid kolondur. Kolorektal tutumlu DİEnin tıbbitedavisi endometriotik odaklar üzerinde herhangi bir küratif etki etmeden semptomatik rahatlamasağlar. Tanısal bir laparoskopi sırasında tesadüfen saptandığında kolorektal endometriozis tedavisiklinisyenler için major bir sorundur. Rektovajinal veya barsak endometriozisinin medikal vecerrahi tedavisini birbiri ile karşılaştıran randomize kontrollü çalışmalar olmadığı için cerrahitedavi modalitelerinin semptomlarda klinik düzelme, komplikasyonlar, rekürrens ve gebelikoranları üzerine etkisi bilinememektedir. Güncel literatüre göre, barsak oklüzyonu ve/ veya rektalkanama olmadan mukozal tutulum olan DİE vakaları invazif bir teknik olan barsak rezeksiyonu veanastomozundan daha düşük komplikasyon ve rekürrens oranlarına sahip olduğundan dolayı özelolarak traşlama adı verilen konservatif bir teknikle tedavi edilmelidirler.

Gastrointestinal tutulum olan ileri evre ve rektovaj inal endometriozisin lap aroskop ik yönetimi: Güncel literatürün bir derlemesi

Endometriosis is the presence of endometrial gland and stromal tissue outside the uterus with apotentially invasive nature despite being a benign disease process. The exact prevalence of thedisease is not known but 10-15% of reproductive age women are affected. The peritoneal andrectovaginal endometriosis are two distinct entities of the disease with different symptoms andtreatment strategies. Dyschezia and deep dyspareunia with nodularity on sacrouterine ligamentsduring rectovaginal examination are specific symptoms of deeply infiltrating endometriosis (DIE).Rectovaginal or bowel involvement is estimated to be present in 5 to 12 percent of women withendometriosis and the most common site is the rectosigmoid colon. Medical treatment of DIE withcolorectal involvement results with symptomatic relief without any curative effect onendometriotic foci. Colorectal endometriosis treatment is a major challenge for the clinicians whenincidentally encountered during a diagnostic laparoscopy. As randomised controlled studiescomparing medical with surgical treatment for rectovaginal or bowel endometriosis are lacking;the impact of the surgical treatment modalities on clinical improvement of the symptoms,complications, recurrence and pregnancy rates is not known. Current literature indicates that,patients without bowel occlusion and/ or rectal bleeding with mucosal involvement caused by DIEshould be treated with conservative technique specifically described as shaving method thathave lower complication and recurrence rates than the invasive technique including bowelresection and anastomosis.

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