Laparoscopic management of rectovaginal septum endometriosis
DOI:
https://doi.org/10.18597/rcog.580Keywords:
endometriosis, laparoscopic surgery, rectovaginal septumAbstract
The experience shows that obliteration of the cul-de-sac secondary to endometriosis can be effectively treated laparoscopically by cul-de-sac dissection with excision of deep fibrotic endometriosis and restoration of cul-de-sac anatomy resulting in resolution of infertility, pelvic pain, and hypermenorrhea in most cases.
Patient benefits include avoidance of major abdominal surgery with its related morbidity or ovarian suppressive therapy that prohibits fertility during administration and doses not appear to penetrate deep, infiltrating endometriotic lesions.
The laparoscopic approach can be lengthy, and the persistent nature of the disease may dictate more than one application. Therefore, significant determining factors in achieving the desired outcome may be a combination of surgical skill and tenacity and patient persistence.
The major contraindication of this procedure is the inexperience of the surgeon. Surgeon advocating vaporization of endometriosis should avoid this operation and make an appropriate referral. This surgery can be more demanding than radical hysterectomy or ovarian cancer operation.
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