JEPPD ISSN 2284-0265
Journal of Endometriosis and Pelvic Pain Disorders 2016; 8(4): 184 DOI: 10.5301/je.5000259
video article
Conservative management using the triple approach and the Rouen technique in large deep rectovaginal endometriosis Horace Roman1,2, Basma Darwish1, Jean-Jacques Tuech3,4 Expert Centre in Diagnostic and Management of Endometriosis, Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen - France 2 Research Group EA 4308 �Spermatogenesis and Male Gamete Quality’, Rouen University Hospital, Rouen - France 3 Department of Digestive Surgery, Rouen University Hospital, Rouen - France 4 Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, Rouen - France 1
Abstract Background: Colorectal resection is performed in numerous patients presenting with large endometriosis of mid and lower rectum; however, it may lead to low anterior rectal resection syndrome. To avoid such outcomes, we propose an original technique combining vaginal excision of infiltrated vaginal cul de sac, laparoscopic deep rectal shaving and transanal disc excision using a semi-circular stapler: the Rouen technique. Methods: The video presents the procedure performed in a 31-year-old nullipara referred with a large endometriotic nodule infiltrating the vaginal posterior cul de sac and the anterior wall of the mid rectum on more than 30 mm length responsible for symptomatic stenosis. The first step of the procedure is represented by the excision of vaginal infiltration using a vaginal approach. The second step includes a laparoscopic deep rectal shaving performed using exclusively the plasma energy. Then, transanal excision is performed from rectal approach, by placing traction parachute sutures on the shaved area. Their traction induces the prolapse of shaved rectal wall that is resected using a semi-circular stapler. Results: Operative time was 140 min. Immediate postoperative outcomes were uneventful. One year after the surgery, the patient reported one stool/day, without dyskesia, normal anal continence and no deep dsypareunia. To date, the Rouen technique was successfully carried out in 42 women with large deep endometriosis of the mid and lower rectum. Conclusions: The Rouen technique is feasible and reproducible in large mid and lower rectal endometriosis and might avoid the risk of unfavourable outcomes related to low colorectal resection. Keywords: Colorectal endometriosis, Colorectal resection, Deep endometriosis, Disc excision, Full thickness excision, Transanal stapler Conflict of interest: Horace Roman reports personal fees for participating in a symposium and a masterclass presenting his experience in the use of PlasmaJet. Basma Darwish and Jean-Jacques Tuech have no conflict of interest.
References 1.
2.
Disclosures Financial support: No grants or funding have been received for this study.
3. 4.
Accepted: November 16, 2016 Published online: December 22, 2016 Corresponding author: Horace Roman Clinique Gynécologique et Obstétricale, CHU Charles Nicolle 1 rue de Germont, 76031 Rouen, France
[email protected]
5. 6.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922-928. Roman H, Bridoux V, Tuech JJ, et al. Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol. 2013;209(6):524-530. Darwish B, Roman H. Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol. 2016;215(2):195-200. Roman H, Darwish B, Schmied R, Remorgida V, Tuech JJ. Combined vaginal-laparoscopic-transanal approach for reducing bladder dysfunction after conservative surgery in large deep rectovaginal endometriosis. J Gynecol Obstet Biol Reprod (Paris). 2016;45(6):546-548. Possover M, Diebolder H, Plaul K, Schneider A. Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol. 2000;96(2):304-307. Roman H, Abo C, Huet E, et al. Full thickness disc excision in deep endometriotic nodules of the rectum. A prospective cohort. Dis Colon Rectum. 2015;58(10):957-966. © 2016 Wichtig Publishing
