Deep Endometriosis of the Bowel is a complex and often misunderstood condition.
Unlike routine endometriosis, Deep Endometriosis of the Bowel features a significantly higher level of fibrosis (thickening and scarring of connective tissue) and minimal glands and stroma.
This condition predominantly affects the large bowel, particularly the rectum and sigmoid colon, but may also involve the appendix and the Pouch of Douglas. It can be associated with nodular growths in the ureter and parametrium.
In rare cases, it can occur outside the pelvis, affecting areas such as scar tissue, the umbilicus, and the diaphragm.
Symptoms of Deep Endometriosis of the Bowel can include atypical pain during intercourse, deep pelvic pain, discomfort during bowel movements, and occasional bleeding with menstrual cycles. These symptoms may suggest a larger nodule or disease that has invaded the bowel mucosa.
As the condition progresses, pain may persist despite medication. Some women may experience dyschezia, characterized by pain during bowel movements.
Advancements in medical technology have improved the diagnosis of this condition, especially through high-quality ultrasound examinations. While a colonoscopy can help diagnose mucosal lesions, it is not necessary for all patients, as only a limited number of lesions actually spread to the mucosa.
Deep Endometriosis of the bowel currently has no medical management. Despite some claims, medications cannot cure this condition due to its limited glandular component.
There are four primary surgical options:
1. Adhesiolysis
2. Shaving
3. Discoid excision
4. Resection anastomosis of the bowel
The choice of method is based on pre-surgical ultrasound results and made by the surgical team.
There is no proven advantage of Robotic Surgery over Laparoscopic Surgery for endometriosis, even for deep lesions. Although some patients choose robotic surgery due to perceived safety, literature indicates no additional benefits. Moreover, Robotic Surgery can be more costly and may face insurance coverage issues.
3D laparoscopic surgery remains the best option for treating endometriosis. When performed by an expert, it can reduce recurrence rates to less than 3%. After surgery, patients with normal fallopian tubes may conceive naturally. Most patients are discharged within 72 hours and can resume travel.
Selecting the right doctor for adenomyosis and endometriosis treatment is crucial. Choosing a specialist in fertility and 3D laparoscopic surgery ensures comprehensive care.
Regarding stomas, not all patients with bowel endometriosis require one. Stomas are not routinely performed for resection anastomosis of bowel endometriosis.
Patients are typically advised to follow up annually for three years after surgery. Post-surgery, some may experience urgency in passing stools or difficulty with evacuation, particularly after a large bowel resection.
A specialized technique called Mesenteric preservation is used during bowel resections for endometriosis. This approach preserves most nerves, allowing for quicker normalization of bowel motility after surgery.
Deep Endometriosis can recur, but with a skilled surgeon, recurrence rates can be significantly reduced. Techniques developed for bowel endometriosis have achieved recurrence rates of less than 2-3%, compared to 30% with less experienced surgeons.
In conclusion, managing Deep Endometriosis of the Bowel requires specialized care. With appropriate treatment and support, patients can effectively manage their symptoms and enhance their quality of life.
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