Bowel endometriosis: diagnosis and management - 23/11/17

Doi : 10.1016/j.ajog.2017.09.023

Camran Nezhat, MD, FACOG, FACS ^a,^b,^c, Anjie Li, MD ^a,^b, Rebecca Falik, MD ^a,^b, Daniel Copeland, MD ^c, Gity Razavi, MD ^a, Alexandra Shakib, BS ^d, Catalina Mihailide, BA ^e, Holden Bamford, BA ^f, Lucia DiFrancesco, MD ^g, Salli Tazuke, MD ^a,^b,^h, Pejman Ghanouni, MD, ACS ^b, Homero Rivas, MD, FACS ^b, Azadeh Nezhat, MD, FACOG ^a,^b,^c, Ceana Nezhat, MD, FACOG, FACS ⁱ, Farr Nezhat, MD, FACOG, FACS ^j,^k,^l,^m,^⁎
^a Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
^b Stanford University Medical Center, Stanford, CA
^c University of California–San Francisco, School of Medicine, San Francisco, CA
^d University of California–Santa Cruz, Santa Cruz, CA
^e University of California–Berkeley, Berkeley, CA
^f Department of Engineering, Stanford University, Stanford, CA
^g Università La Sapienza, Obstetrics and Gynecology, Rome, Italy
^h Colorado Center for Reproductive Medicine, San Francisco, CA
ⁱ Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
^j Nezhat Surgery for Gynecology/Oncology, Lynbrook, NY
^k Weill Cornell Medical College, Cornell University, New York, NY
^l Gynecology and Reproductive Medicine, School of Medicine, Stony Brook University, Stony Brook, NY
^m Minimally Invasive Gynecologic Surgery and Robotics, Winthrop University Hospital, Winthrop University Hospital

^∗Corresponding author: Farr Nezhat, MD, FACOG, FACS.

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Abstract

The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.

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Key words : bowel endometriosis, extra-genital endometriosis, laparoscopic surgery, pelvic pain