July 21st, 2018

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Laparoscopic Diagnosis and Management of Deep Infiltrating Endometriosis Located on the Rectovaginal Septum
Authors:  Li-Li Cao, M.M., Hui-Ling Qiu, M.D., Ying Wang, M.M., Yan Xu, M.D., and Hui-Cheng Xu, M.D., Ph.D.
  OBJECTIVE: To describe the clinical and laparoscopic diagnosis and management of patients with deep infiltrating endometriosis of the rectovaginal septum.

STUDY DESIGN: A retrospective study was performed of 24 patients with rectovaginal septum endometriosis who underwent laparoscopic surgery between 2004 and 2011. All patients contributed to telephone interviews as follow-up. Quality of life and visual analogue scale (VAS) survey scores for symptoms associated with endometriosis were evaluated.

RESULTS: A distinctive endoscopic pathology was shown and typical symptoms reported by the patients, including type of pelvic pain and bowel symptoms. Surgical morbidity was 16.7%; 1 patient required re-operation. Postoperatively, 11, 2, and 3 patients received gonadotropin-releasing hormone agonist treatment, medroxyprogesterone acetate, and a levonorgestrel-releasing intrauterine device, respectively. No patients had clinical signs of recurrence of rectovaginal septum endometriosis, but 1 patient had objective signs of ovarian endometriomas. Of the 9 patients who desired pregnancy after surgery, 6 conceived, and 4 delivered healthy newborns. Postoperative quality of life and VAS scores significantly improved from the preoperative.

CONCLUSION: Laparoscopic surgery can accurately diagnose rectovaginal septum endometriosis. Moreover, laparoscopic surgery for rectovaginal septum endometriosis is relatively effective, can remove all visible lesions, and improves quality of life for these patients.
Keywords:  diagnosis, endometriosis, gynecologic surgery, laparoscopy, management, quality of life, rectovaginal septum endometriosis
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