Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
Department of Gynecology, Obstetrics, and Reproductive Medicine, Saarland University Medical Center, Homburg, Saar, Germany.
Surg Endosc. 2024 Aug;38(8):4677-4679. doi: 10.1007/s00464-024-10969-7. Epub 2024 Jun 19.
Endometriosis is a chronic, inflammatory, and hormone-dependent disease that affects approximately 10% of women in reproductive age. Endometriosis is categorized into different types, as superficial, deep, and ovarian endometriosis. When deep endometriosis occurs, the sigmoid and rectum are often affected (Becker et al. in Hum Reprod Open, 2022, https://doi.org/10.1093/hropen/hoac009 ). In the following article, we aim to demonstrate stepwise surgery for stage IV endometriosis involving the anterior rectosigmoid.
We present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment endometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate incorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, interdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned.
The total laparoscopic approach is demonstrated step by step in the video.
Deep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, preoperative endometriosis-specific imaging should be performed for optimal surgical planning. Experienced endometriosis multidisciplinary surgical teams can provide specialized and high-quality care for patients suffering from this debilitating disease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X ).
子宫内膜异位症是一种慢性、炎症性和激素依赖性疾病，影响大约 10%的育龄妇女。子宫内膜异位症分为不同类型，包括浅表型、深部型和卵巢型。当深部子宫内膜异位症发生时，乙状结肠和直肠经常受到影响（Becker 等人，发表于《人类生殖学开放杂志》，2022 年，https://doi.org/10.1093/hropen/hoac009）。在下面的文章中，我们旨在展示累及前直肠乙状结肠的 IV 期子宫内膜异位症的分步手术。
我们介绍了一位 26 岁肥胖（BMI 35.87）女性的病例，她患有严重的后盆腔子宫内膜异位症、持续性腹痛和便秘。盆腔术前 MRI 观察到一个 13cm 的卵巢（亲吻卵巢）、子宫浆膜和前直肠乙状结肠的复合物（图 1）。因此，计划由妇科医生和结直肠外科医生进行多学科腹腔镜手术。
视频中逐步展示了全腹腔镜方法。
深部子宫内膜异位症是一种罕见的情况。当怀疑涉及其他器官（例如肠道）时，应进行特定于子宫内膜异位症的术前影像学检查，以进行最佳手术规划。经验丰富的子宫内膜异位症多学科手术团队可以为患有这种使人衰弱的疾病的患者提供专业和高质量的护理（Luna Russo 等人，发表于《妇产科》，2020 年，https://doi.org/10.23736/S0026-4784.20.04544-X）。
