Laparoscopic discoid excision of bowel endometriosis using sutures for closure

Elsevier

Available online 18 November 2022

Journal of Minimally Invasive GynecologyAuthor links open overlay panelAbstractObjective

: To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device.

Design

: Stepwise demonstration of the technique with narrated video footage.

Setting

: Bowel endometriosis is a common pattern of deep endometriosis (1). Discoid excision is one of the three surgical interventions applied to manage this pathologic entity with shaving and segmental resection being the other two(2). When discoid excision is performed, a transanal stapler device is used for bowel closure in the majority of cases (3, 4). Only a few studies so far, have reported the application of sutures for this purpose(5). This video highlights the technique of bowel suturing after discoid excision.

Interventions

: This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect. The key surgical steps are: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve 3. Detachment of the nodule form the cervix 4. Detachment of the nodule form the bowel beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using two layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous.

Conclusion

: The described technique of bowel closure using sutures may be a safe and effective alternate to the transanal stapler. It's advantage is the ability to perform it when the pathology is located higher than 15cm form the anal verge or the diameter of the nodule is more than 30mm.

Keywords

Discoid excision

deep endometriosis

laparoscopy

© 2022 Published by Elsevier Inc. on behalf of AAGL.

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