Laparoscopic excision of endometriosis may require unilateral parametrectomy

Abstract

Objective: We investigated the effects of laparoscopic excision of endometriosis with unilateral parametrectomy on bladder, rectal, and sexual function as well as patient satisfaction.

Methods: Women who underwent this procedure between February 1, 2006 and November 15, 2007 were enrolled. Patient characteristics, pre- and postoperative findings, and follow-up data were retrospectively collected from a computerized database.

Results: Twelve patients were enrolled in the study. All of the symptoms except dysuria improved after surgery, worsening long after the operation. It seems that all parameters including sexuality, micturition, and defecation are equally important in regards to the final judgement of satisfaction, with a trend towards amelioration long after the operation.

Conclusions: Unilateral parametrectomy may offer successful results in terms of patient satisfaction despite some impairment in bladder, bowel, and sexual function. The risk of permanent functional impairment is high; therefore, surgeons need to maintain the integrity of the contralateral nerve pathway. This is highly important, because pain relief seems to be partially involved in the final judgement of postoperation satisfaction.

Figure 1.

Left Hypogastric Nerve (LHN) that digs into the left parametrium deeply invaded by endometriosis (parametrial nodule = PN). Note how endometriosis strictly adheres to the distal part of the hypogastric nerve so that its transaction was considered necessary to complete the removal of endometriosis (R = rectum; LU = left ureter)

Figure 2.

Final result after left parametrectomy and rectosigmoid resection before bowel anastomosis. Note the stump of the left hypogastric nerve (yellow circle). Rectal stump = RS; Right ureter = RU; Right hypogastric nerve = RHN; Left ureter = LU.