Surgery: Rectovaginal septum, endometriosis or adenomyosis: Laparoscopic management in a series of 231 patients
Abstract
A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.
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A progestogen (lynestrenol) was unable to reduce vascularization in endometriotic lesions, but a significant decrease was observed after GnRH agonist therapy.
“a progestogen (lynestrenol) was unable to reduce vascularization (evaluated by the capillary–stroma relative surface area) in endometriotic lesions, but a significant decrease was observed after GnRH agonist therapy [55].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [55]
The risk of venous or arterial thrombosis with OCPs is not negligible.
“the risk of venous or arterial thrombosis is not negligible [54,55,56,57,58,59,60,61,62,63,64,65,66,67].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [55]
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“The second theory is that of metaplasia (Meyer, 1919), either of the celomic metaplasia (Gruenwald, 1942) or Mullerian remnants metaplasia (Donnez et al., 1995).”
The effect of surgery for symptomatic endometriosis: the other side of the story
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“…surgery has been performed differently, as some authors support simple nodulectomy (disk resection) (Reich et al., 1991; Candiani et al., 1992; Donnez et al., 1995, 1997; Anaf et al., 2001; Chapron et al., 2001; Angioni et al., 2006; Kristensen and Kjer, 2007) and others low anterior…”
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“It is hard to prove this hypothesis in view of the absence of outcome studies reporting recurrence after disc excision, shaving or superficial excision except for one study published 15 years ago (Donnez et al., 1995).”
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“The surgical technique used was described previously (Donnez et al., 1995).”
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“, (Donnez et al., 1995).”
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“Some authors found the presence of abundant smooth muscle cells in this area (Donnez et al., 1995).”
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“endometriosis is histologically indistinguishable from uterine adenomyoma (Donnez et al., 1995).”
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“[55] If disease is infiltrating the rectovaginal septum, the recurrence rate may be higher.[56] The relationship between adhesions and pain is”
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Current Thinking on the Pathogenesis of Endometriosis
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Self-citationBladder Endometriosis: Deep Infiltrating Endometriosis or Adenomyosis?
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“The surgical procedure that we use in rectal nodule excision is similar to that performed by other surgical teams and as first described by Donnez et al. (1995). Both pararectal spaces are opened below the lateral limits of the rectal nodule and the rectovaginal space is reached under the inferior limit of the nodule.”
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“377 378 Donnez et al have published extensively on clinical outcomes following largely the 379 shaving technique and have reported both low complications and recurrence 380 rates(7, 23).”
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Endometriosis and adenomyosis: Similarities and differences
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“The first step is performed laparoscopically, and involves rectal shaving similar to that described by Donnez et al. (1995).”
BackgroundMethodIs Endometriosis Really Associated with Pain?
Momoeda, M., Taketani, Y., Terakawa, N., Hoshiai, H., Tanaka, K., Tsutsumi, O., Osuga, Y., Maruyama, M., Harada, T., Obata, K., et al. (2002) · Gynecologic and Obstetric Investigation · doi:10.1159/000066290 · Cited by 39 · see citing works
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Self-citationTargeting Mast Cells in Endometriosis with Janus Kinase 3 Inhibitor, JANEX‐1
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“The latter approach may be performed without opening the rectum (shaving) or by removing the nodule along with the surrounding rectal wall (full thickness or disc excision) (Nezhat et al., 1993; Koninckx et al., 1994; Donnez et al., 1995, 1997; Roman et al., 2011).”
BackgroundDonnez, J., & Nisolle, M. (1995) · Baillière s Clinical Obstetrics and Gynaecology · doi:10.1016/s0950-3552(05)80398-0 · Cited by 36 · see citing works
Self-citationRectal shaving using PlasmaJet in deep endometriosis of the rectum
Roman, H. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.07.1973 · Cited by 35 · see citing works
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“patients to severe postoperative complications such as rectovaginal fistulae and neurogenic bladder [1,6–10].”
Focusing on surgery results in infertile patients with deep endometriosis
Angioni, S. L., Cela, V., Sedda, F., Loi, E. S., Cofelice, V., Pontis, A., & Melis, G. B. (2015) · Gynecological Endocrinology · doi:10.3109/09513590.2015.1062868 · Cited by 32 · see citing works
Bersinger, N. A., Déchaud, H., McKinnon, B. D., & Mueller, M. D. (2012) · Archives of Physiology and Biochemistry · doi:10.3109/13813455.2012.687003 · Cited by 31 · see citing works
“…although now considered as a collection of related conditions characterized by disparate morphological, histological and biochemical properties (Donnez et al., 1995; Nisolle and Donnez, 1997), is increasingly being recognized as being an inflammatory disease in an altered pelvic environment…”
BackgroundDonnez, O. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10215183 · Cited by 29 · see citing works
“Avoiding vaginal fornix excision is recommended by a number of authors, as it might be associated with increased complication rates [50,51,74].”
BackgroundTurco, L., Scaldaferri, F., Chiantera, V., Cianci, S., Ercoli, A., Fagotti, A., Fanfani, F., Ferrandina, G., Nicolotti, N., Tamburrano, A., et al. (2019) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-019-05382-8 · Cited by 27 · see citing works
Rectovaginal endometriosis – a frequently missed diagnosis
Griffiths, A., Koutsouridou, R. N., & Penketh, R. (2007) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443610701497660 · Cited by 30 · see citing works
“Surgical excision is a highly effective method of treatment (Donnez et al. 1995; Nezhat et al. 1992).”
MethodLAPAROSCOPICALLY ASSISTED VAGINAL RESECTION OF RECTOVAGINAL ENDOMETRIOSIS
Possover, M., Diebolder, H., Plaul, K., et al. (2000) · Obstetrics and Gynecology · doi:10.1097/00006250-200008000-00029 · Cited by 30 · see citing works
Vésale, E., Roman, H., Moawad, G., Benoit, L., Touboul, C., Daraï, É., & Bendifallah, S. (2020) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2020.07.019 · Cited by 31 · see citing works
KRISTENSEN, J., & Jørgen Kjer, J. (2007) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1080/00016340701645006 · Cited by 27 · see citing works
Deep endometriosis: The place of laparoscopic shaving
Donnez, O., & Donnez, J. (2021) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2020.05.006 · Cited by 28 · see citing works
Self-citationLaparoscopic treatment of symptomatic endometriosis
Pouly, J.-L., Drolet, J., Canis, M. J., Boughazine, S., Mage, G., Bruhat, M. A., & Wattiez, A. (1996) · Human Reproduction · doi:10.1093/humrep/11.suppl_3.67 · Cited by 27 · see citing works
Diagnosis and treatment of rectovaginal endometriosis: an overview
KRUSE, C., SEYER‐HANSEN, M., & FORMAN, A. (2012) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2012.01367.x · Cited by 26 · see citing works
Vitale, S. G., Rosa, V. L. L., Vitagliano, A., Noventa, M., Laganà, F. M., Ardizzone, A., Rapisarda, A. M. C., Terzić, M., Terzic, S., & Laganà, A. S. (2017) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.5301/jeppd.5000303 · Cited by 25 · see citing works
Multidisciplinary laparoscopic treatment for bowel endometriosis
Wolthuis, A. M., & Tomassetti, C. (2013) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2013.11.008 · Cited by 25 · see citing works
Choosing the right technique for deep endometriosis
Nisolle, M., Brichant, G., & Tebache, L. (2019) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2019.01.010 · Cited by 24 · see citing works
Self-citationUterine rupture following laparoscopic resection of rectovaginal endometriosis: a new risk factor?
Putte, I. V. D., Campo, R., Gordts, S., & Brosens, I. A. (1999) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1999.tb08334.x · Cited by 23 · see citing works
Varlas, V. N., Rhazi, Y., Cloțea, E., Roxana Georgiana, B. O. R. S., Mirică, R., & Bacalbaşa, N. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10163749 · Cited by 23 · see citing works
Campin, L., Borghese, B., Marcellin, L., Santulli, P., Bourret, A., & Chapron, C. (2014) · Journal de gynécologie, obstétrique et biologie de la reproduction. Supplément/Journal de gynécologie obstétrique et biologie de la reproduction · doi:10.1016/j.jgyn.2014.03.003 · Cited by 22 · see citing works
Endometriose de septo retovaginal: doença de diagnóstico e tratamento específicos
Abrão, M. S., Neme, R. M., & Averbach, M. (2003) · Arquivos de Gastroenterologia · doi:10.1590/s0004-28032003000300011 · Cited by 20 · see citing works
Turco, L., Tortorella, L., Tuscano, A., Palumbo, M., Fagotti, A., Uccella, S., Fanfani, F., Ferrandina, G., Nicolotti, N., Vargiu, V., et al. (2020) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-020-05694-0 · Cited by 17 · see citing works
Langebrekke, A., Istre, O., Busund, B., Johannessen, H., & Qvigstad, E. (2006) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340500449907 · Cited by 20 · see citing works
“Our experience was in line with other publications that emphasize the importance of preoperative evaluation (2,4).”
Result
- Authors
- Donnez, J., Nisolle, M., Casanas-Roux, F., Bassil, S., & Anaf, V.
- Affiliations
- Cliniques Universitaires Saint-Luc (BE)
- ORCID
- Nisolle, M.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 1995-03
- Volume
- 10
- Issue
- 3
- Pages
- 630-635
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2120545985
- Cited by
- 175
- References
- 0
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 6 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 3 · 2013: 12 · 2012: 5
- FWCI
- 7.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Open Repository and Bibliography (University of Liège) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- rectovaginal septum, deep infiltrating endometriosis, laparoscopic resection, endometriotic nodules, Müllerian remnants, urinary retention, analgesia, adenomyoma
- MeSH terms
- Endometriosis, Female, Humans, Image Processing, Computer-Assisted, Infertility, Female, Laparoscopy, Radiography, Rectal Diseases, Vaginal Diseases, Pelvic Pain
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