Anterior rectal wall excision for endometriosis using the circular stapler

Background:  Endometriosis involving the rectum is rare but is associated with significant symptoms that are best relieved by resection of the involved segment of rectum. Resection necessitates either a segmental or anterior rectal wall excision with sutured closure. Application of a circular stapling device allows an alternative technique to resect endometriosis in this area. Method:  Following laparascopic ablation of endometriosis elsewhere in the pelvis , the rectum must be mobilized around disease present on the anterior rectal wall. This will involve lateral and anterior extraperitoneal rectal dissection; the latter dissection mobilizing the vagina from the rectum by a sufficient length necessary to allow imbrication of the diseased area. Insertion of a circular stapler per anus allows the diseased area to be imbricated into the stapler, resulting in simultaneous excision and closure of the anterior rectal wall. Results:  Thirty patients with anterior rectal wall endometriosis, estimated at <2 cm in diameter and not involving > one‐third of the total circumference of the rectum, have undergone successful management using this technique. Morbidity occurred in four patients, with one patient requiring further surgery. Conclusions:  Laparascopic disc excision of deposits of endometriosis involving the anterior rectal wall can be safely performed utilizing the circular stapler without the need for open surgery, and with low morbidity.