The first video prize was presented to Horace Roman at the closing ceremony of the 12th World Congress on Endometriosis for his new excision procedure to low and mid rectal endometriosis nodules using a combined transanal and laparoscopic approach.
Dr Roman reported preliminary results of a new technique for transanal full thickness disc excision of rectal endometriosis nodules in a prospective series of patients undergoing a new surgical procedure. The video prize was sponsored by WCE2014 hosts, SBE.
Methods
Patients benefited from the combined laparoscopic and transanal excision of rectal nodules using the Contour Transtar stapler (Ethicon Endosurgery Inc). First, the rectal area infiltrated by the nodule was shaved, then the general surgeon seized the shaved area into the transanal stapler jaws and performed a large disc excision.
Results
SBE President, Rui Ferriani, congratulates Horace Roman on his prize at the WCE2014 Closing Ceremony
The procedure was successfully performed in 12 women with symptomatic deep endometriosis infiltrating the low- and mid-rectum. They represented 7.5% of 162 women managed during this same period by various procedures for rectal nodules. The height of the nodules ra,ged from 40 to 100 mm above the anus (median 60 mm). The postoperative follow up ranged from 6 to 43 months (median 26 months). The largest diameter of specimens varied from 40 to 80 mm (55±11 mm). The postoperative follow up ranged from 6 to 43 months (median 26 months). One rectovaginal fistula was recorded in a patient undergoing large vaginal resection. Median postoperative value for the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott-Symptom Questionnaire was 114±15 (range 90-137) and 8±7 (range 1-20) respectively.
Conclusion
Dr Roman’s data suggest that this new technique of transanal rectal disc excision using the contour stapler may be applied in patients with infiltrating endometrial nodules of the rectum up to 10 cm from the anal margin and up to 5 cm in diameter, thus it specifically avoids low colorectal resections.