Deeply infiltrating endometriosis (DIE) is a debilitating condition that can have profound impacts on reproductive health and quality of life.
We describe the standard preoperative and operative approach to the management of a large rectovaginal endometriotic nodule in a large urban tertiary referral unit.
All patients with suspected DIE undergo an endometriosis pelvic ultrasound after bowel preparation. This is performed by a gynaecologist with sub-specialist qualifications in gynaecological ultrasound. This maximises the ability to detect DIE, in particular the amount and degree of bowel involvement. We do not routinely perform a planning laparoscopy.
A multi-disciplinary approach is crucial to the management of patients with endometriosis affecting the large bowel. Patients are counselled extensively preoperatively, both by the operating gynaecologist and a colo-rectal surgeon with a dedicated interest in endometriosis. A preoperative colonoscopy is only performed in the presence of suspicious symptoms, which is rare. Full bowel preparation is required preoperatively. Lastly, patients with lesions greater than 3cm undergo a CT and IVP to out rule ureteric involvement.
A joint laparoscopic approach by a gynaecologist and a colo-rectal surgeon is the standard approach in our unit. We will present a video outlining our unit’s approach to dissection of the rectovaginal septum and excision of a full thickness vaginal nodule.