Yutaka Kojima, MD, Kazuhiro Sakamoto, MD, Yuichi Tomiki, MD, Michitoshi Goto, MD, Makoto Takahashi, MD, Yukihiro Yaginuma, MD, Masaki Hata, MD, Shun Ishiyama, MD, Kiichi Sugimoto, MD, Kazuhiro Takehara, Jun Aoki, MD, Yu Okazawa, MD
Juntendo University Faculty of Medicine, Tkyo, Japan
[Objective] Endometriosis develops in women of reproductive age at a high frequency of about 10%. Intestinal endometriosis is a disease that is characterized by the ectopic growth of endometrial-like tissues, which develops most likely in the ovary and pelvic peritoneum and can also involve the intestinal tract. Intestinal endometriosis has been reported to develop in 5 to 37% of patients with endometriosis. Patients who are resistant to pharmacotherapy may require surgery. We report our 11 patients with intestinal endometriosis who underwent laparoscopic bowel resection.
[Subject and Method] Eleven (11) patients who received a 6-month course of hormone treatment for intestinal endometriosis from 2002 to 2011 but were refractory to the therapy and subsequently underwent laparoscopic bowel resection were evaluated in terms of their age, symptoms, sites, barium enema findings, colonoscopy findings, technique, operating time, volume of bleeding, results of histopathological examinations, and postoperative course.
[Result] Their age ranged between 28 and 42 years old with a mean age of 35.5 years. They all presented with painful defecation or dyschezia. Furthermore, 7 patients had hematochezia, and 2 of the patients had the symptom regardless of menstruation. The lesions were located in the sigmoid colon and the rectum, including rectosigmoid (6 patients) and rectum above the peritoneal reflection (4 patients). Barium enema revealed the presence of stenosis in all patients. Colonoscopy showed stenosis and/or edema 7 to 18 cm from the anal verge, which were all inflamed mucosa according to the biopsy. The technique employed in this study was laparoscopic lower anterior resection, and oophorocystectomy, leiomyomectomy and ileocecal resection for lesions in the distal ileum were added in 2 patients, 2 patients and 1 patient, respectively. The operating time ranged from 240 to 480 minutes and the mean was 352.2 minutes. The volume of bleeding was 30 to 600 ml with a mean of 212.6 ml. As for the depth of invasion, the tumor invaded the muscularis propria in all patients and reached the submucosa in 9 patients. The intraoperative distal resection margin was positive in 1 patient and it was therefore also resected. The remaining 10 patients were negative. The postoperative course was good in 9 patients, but 2 patients had melena again which was considered as recurrence.
As the social background, such as the tendency to marry later, changes, the incidence of endometriosis grows. Accordingly, the likelihood of intestinal endometriosis it also likely to increase. The first choice for intestinal endometriosis is hormone treatment, but surgery is required in patients who are resistant to pharmacotherapy. Laparoscopic surgery for intestinal endometriosis has disadvantages in that it requires a longer duration and may unavoidably induce a greater volume of intraoperative bleeding than other equivalent surgical procedures. But in intestinal endometriosis, laparoscopic surgery is less invasive and is useful in obtaining information regarding the extent of lesions and lesions at other sites.
Session: Poster Presentation
Program Number: P513