Deep rectovaginal endometriotic nodules: Perioperative complications from a series of 3,298 patients operated on by the shaving technique

Abstract

The purpose of this study was to analyze complication and recurrence rates after deep endometriotic nodule surgery. A total of 3,298 cases of deep endometriotic nodules were analyzed. The shaving technique was used, avoiding bowel resection. Laparoscopic nodule resection was performed successfully in all cases. Major complications included: (1) rectal perforation in 42 cases (1.3 %), (2) ureteral retention (<5 days) in 21 cases (0.64 %), (3) ureteral injury in 10 cases (0.3 %), and (4) fecal peritonitis in 1 case (0.04 %). This complication rate is much lower than that observed after bowel resection. In the same period, bowel resection was only required in 1.1 % (n = 37) of cases. Histology revealed circumscribed nodular aggregates of smooth muscle, endometrial glands, and scanty endometrial stroma. Lesions were found to be invaded by nerve fibers. Endometriosis is not cancer and does not require the same treatment approach. In young women, conservative surgery using the shaving technique means preservation of organs, nerves, and the vascular blood supply. The shaving technique yields low complication and recurrence rates and should be considered the first line in surgical approach in the case of deep endometriotic lesions. © 2012 Springer-Verlag.