Laparoscopic excision of transmural rectal endometriosis

Dr. Einarsson: This was actually a video that showed a transmural resection of endometriosis of the rectum. We’ve been developing a slightly less invasive technique for removal of the transmural bowel nodules. So instead of doing a bowel resection, we’ve been offering patients a slightly less invasive approach where we can excise the nodule directly from the bowel and then repair the bowel. A lot of these patients are young women that may be at a higher risk for permanent nerve damage or other functional issues if you have a bowel resection. We’re trying to solve the issue with the endometriosis and associated symptoms without creating new problems for them. 

What is the impact for ob/gyns?Dr. Einarsson: A bowel endometriosis is a fairly common finding in women with endometriosis; about 5% of women that have endometriosis have bowel involvement. I think that while a generalist or an ob/gyn specialist can take care of many of these patients, the patients that have very large pathology or a deeply infiltrated nodule are probably better served by having a high-volume surgeon take care of the surgery. But I think increased recognition of different treatment options, surgically, is important for all ob/gyns in practice to know about. 

Were you surprised by the findings?Dr. Einarsson: What is, maybe somewhat surprising, is that we are not using any mechanical bowel preparation of the patient to get antibiotics. But with very careful, meticulous suturing of the bowel, even if we enter the bowel without any bowel preparation, those patients tend to do quite well, and we have not had any issues with infection. 

What’s next for your research?Dr. Einarsson: We have to do more long-term research to follow-up on those patients several years after surgery because even if they do well initially for a year or two, I think it’s more meaningful to know how they’re doing 5 or 10 years later. So that’s the long-term follow-up that we need to do over the next few years.

Dr. Einarsson is Professor of Obstetrics and Gynecology, Harvard Medical School and the Director, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Mass.