To evaluate symptom relief following a laparoscopic technique designed for treatment
of complete obliteration of the cul-de-sac associated with endometriosis, with fertility
Preoperative and postoperative questionnaire study of a cohort of patients with complete
obliteration of the cul-de-sac undergoing a standardized laparoscopic surgical treatment.
American tertiary referral center for the surgical treatment of endometriosis.
Eighty-four consecutive patients undergoing laparoscopic treatment of endometriosis
with complete cul-de-sac obliteration with 67 replying to a postoperative questionnaire.
Laparoscopic excision of all endometriosis including treatment of complete obliteration
of the cul-de-sac by en bloc resection and bowel resection as needed.
Symptom relief as measured on a 5-point ranked ordinal scale administered before and
after surgery, as well as perioperative complications, postoperative fertility, and
prognostic value of preoperative findings on pelvic examination.
Symptom reduction was obtained for all symptoms related to cul-de-sac disease, particularly
for patients with severe or debilitating symptoms preoperatively. There was no significant
complication, and the postoperative fertility rate was 43%. Seventy-three percent
of patients with obliteration of the cul-de-sac had histologically proved rectal endometriosis.
Nodularity and tenderness on examination were predictive of symptom improvement.
Aggressive laparoscopic excision of endometriosis carried out in a specialist center
offers good symptom relief, especially for those with severe or debilitating symptoms.
To ensure complete removal of all disease, intestinal surgery is required in most
patients with complete obliteration of the cul-de-sac.