Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis
Reich, H.; McGlynn, F.; Salvat, J.
Journal of Reproductive Medicine 36(7): 516-522
1991
ISSN/ISBN: 0024-7758 PMID: 1834840 Document Number: 376635
One hundred women with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (48 partial, 52 complete) were treated laparoscopically for infertility (46 cases), pain (46), hypermenorrhea (7) and a mass (1). The surgical techniques included aqua-dissection, electrosurgery, CO2 laser, scissors, probes to identify the upper posterior vagina and rectum, and multiple rectovaginal examinations. In all the procedures the anterior rectum was freed to the loose areolar tissue of the rectovaginal septum prior to excising deep fibrotic endometriosis. The viable intrauterine pregnancy rate among patients with infertility was 70% (32/46). Of patients presenting with pain, 89% (41/46) reported significant relief. The average operating time was 178 minutes. Laparoscopic cul-de-sac dissection, though time intensive, offers increased fertility potential and significant symptom relief.