Laparoscopic treatment of bowel endometriosis.

The most common site of extragenital endometriosis is the intestinal tract, which accounts for approximately 80% of all extragenital endometriosis. The symptoms of intestinal endometriosis are crampy pain, flatulence, painful tenesmus, hyper-peristalsis, progressive constipation, diarrhea alternating with constipation, and occasionally rectal bleeding. As endometriosis in this location often undergoes fibrotic changes, it can be resistant to hormonal therapy, which makes surgical therapy the only option for many women. Until recently, laparoscopic treatment of bowel endometriosis was thought to be impossible. Development of several safe and effective techniques for laparoscopic treatment of intestinal endometriosis has made such treatment possible. In this chapter, the authors describe five proven techniques for treatment of intestinal endometriosis: shaving, disk excision, anterior rectal wall excision, segmental resection, and appendectomy.