Endometriosis of the Rectus Muscle: A Single-Center Experience and a Novel Laparoscopic Approach

Abstract

Objective: The aim of this research was to review preoperative and intraoperative findings in patients with rectus muscle endometriosis (RME) and to describe the current authors' novel technique of laparoscopic excision of RME. Materials and Methods: This was a retrospective case series at a single academic institution. The operations in this series were conducted between January 2009 and January 2019. RME was excised laparoscopically or by an open approach, with or without diagnostic laparoscopy to evaluate for pelvic endometriosis. Demographic and perioperative data were obtained from the medical records, and descriptive statistics were generated. Results: Twenty-two patients were included in the analysis. Each of 21 (95%) patients had at least 1 prior cesarean section, and 5 patients each (23%) had a prior excision of abdominal wall endometriosis. All patients reported pelvic or abdominal pain and three-quarters of them reported cyclic pain. One-quarter complained of masses or lumps; however, only 55% had palpable nodules felt on abdominal examinations. All but 1 patient had preoperative imaging, of which 81% were magnetic resonance imaging. Of the 22 cases, 11 (50%) lesions were excised laparoscopically and 11 (50%) were excised with open excision. In 3 patients who had open excisions, laparoscopic evaluation of each patient's pelvis was also performed. Concurrent pelvic endometriosis was present in 71.4% of patients who underwent laparoscopy, with the most-common location being the bladder or ureter (60%). All cases of laparoscopic excision of RME were performed by a minimally invasive gynecologic surgeon. Ninety-four percent of patients reported having complete symptom relief at their postoperative visits. Conclusions: Both open and laparoscopic resection of RME are feasible treatment options and the surgical approach should be determined by specific symptoms, physical examination, and preoperative imaging. Due to the high incidence of concurrent pelvic endometriosis, laparoscopic evaluation of the pelvis should be considered when excision is planned using an open approach.