Clinical Management of Bowel Endometriosis by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030504465
Publisher: Springer International Publishing

Endometriotic nodules of the rectosigmoid are generally associated with advanced disease but the pararectal spaces are generally preserved. By approaching the nodule laterally through these avascular spaces, it is possible to mobilize the bowel off of the uterus and posterior aspects of the vagina. Care must be taken to prevent thermal bowel injury by favoring cold scissors rather than electrosurgical instruments.

Once the uterus and vagina have been mobilized off of the bowel, an atraumatic grasper can be used to define the location and size of the nodule (Fig. 10.4). These graspers can squeeze the nodule and bounce off of the unaffected bowel. This allows the surgeon to evaluate the percentage of the bowel that has nodule involvement. We favor discoid resection in nodules that are 3 cm or less and involving less than half of the circumference of the bowel as that allows an adequately sized lumen after surgery. Intraoperatively, we use a rectal probe to evaluate the diameter of the bowel lumen. If the rectal probe passes easily beyond the nodule, a discoid resection will be able to be performed and leave adequate space for a primary closure. In patients where the rectal probe does not pass easily, a segmental resection should be performed instead.

Fig. 10.4The squeeze technique is performed by using an atraumatic grasper to outline the borders of the rectal nodule. This allows the surgeon to determine if the nodule is amenable to discoid resection or if it is too large and a segmental resection should be performed instead

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