Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results.

BACKGROUND: Although several studies have shown that laparoscopic resection is safe and feasible in bowel endometriosis, limited data are available on the specific treatment for endometriosis of the rectum. The aim of this study is to describe operative and postoperative outcomes after laparoscopic resection of the mid/low rectum for endometriosis. METHODS: Between 2002 and 2010, 750 patients (median age 33 years) underwent laparoscopic resection of the mid/low rectum for deep infiltrating endometriosis at a single institution. All operations were performed with a standardized technique by a single surgeon. RESULTS: Median operative time was 255 min, and median blood loss 150 ml. Of patients, 7\% required blood transfusions. Laparotomic conversion rate was 1.6\%. Mechanical low and very low colorectal anastomoses were carried out in 92.5 and 7.5\% of patients, respectively. Temporary ileostomy rate was 14.5\%. Median length of stay was 8 days. Overall surgical morbidity was 9\% with no mortality. Rates of anastomotic leak, rectovaginal fistula, and intraabdominal bleeding were 3, 2, and 1.2\%. Forty patients (5.5\%) required reoperation. CONCLUSIONS: Laparoscopic resection of the mid/low rectum for endometriosis can be performed safely with acceptable rates of morbidity/reoperation and with low rates of specific complications, including anastomotic leak and rectovaginal fistula. The very high surgical volume of the operating surgeon is probably one of the most important factors in order to maximize postoperative outcomes.