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  • Title: Rectal Shaving Using Plasma Energy in Deep Infiltrating Endometriosis of the Rectum: Four Years of Experience.
    Author: Marty N, Touleimat S, Moatassim-Drissa S, Millochau JC, Vallee A, Stochino Loi E, Desnyder E, Roman H.
    Journal: J Minim Invasive Gynecol; 2017; 24(7):1121-1127. PubMed ID: 28673871.
    Abstract:
    STUDY OBJECTIVE: To evaluate postoperative complications, digestive function and fertility outcomes in patients managed by rectal shaving using plasma energy in deep infiltrating endometriosis of the rectum. DESIGN: A single-center retrospective cohort study using data recorded prospectively. DESIGN CLASSIFICATION: Canadian Task Force classification II-2. SETTINGS: Department of Gynecology and Obstetrics of Rouen University Hospital (France). PATIENTS: One hundred and ten patients treated between December 2012 and December 2016. INTERVENTIONS: Laparoscopic rectal shaving using plasma energy. MEASUREMENTS AND MAIN RESULTS: Clinical history, baseline symptoms, preoperative assessment, intraoperative findings, and postoperative outcomes were recorded prospectively. Follow-up evaluations were performed at 1 year and 3 years. Mean age of patients was 37 ± 6.4 years. Most patients had rectal nodules infiltrating either the mid or upper rectum and measuring <3 cm long. No intraoperative complications were recorded. One patient with multiple previous surgical procedures presented with a postoperative rectovaginal fistula (0.9%), and 1 patient presented with a postoperative rectouterine fistula treated exclusively with antibiotics (0.9%). Two patients (1.8%) had bladder atony necessitating ≥3 weeks of daily self-catheterization. Four patients (3.6%) had Clavien-Dindo grade I complications, 12 (10.9%) had grade II complications, 1 (0.9%) had a grade IIIa complication, 5 (4.5%) had grade IIIb complications, and 1 (0.9%) had a grade 4a complication. The vast majority of patients (n = 103 patients; 93.6%) were free of serious complications. Significant improvements in constipation and gastrointestinal quality of life were recorded at 1 year and 3 years postoperatively. Thirty-two patients attempted pregnancy after surgery (29.1%), and 17 of them conceived (53.1%). CONCLUSIONS: Rectal shaving using plasma energy allows for a low rate of postoperative complications with good digestive function and fertility outcomes and appears to be suitable in selected women with symptomatic rectal endometriosis.
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