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Laparoscopic Surgeries >
  Endometriosis – Rectovaginal diseases  
   

 

Definition:

Performed for Infertility or severe pain in lower abdomen during menstrual period and painful sexual relations or pain during sexual relation or defecation during period.

Indication:
Performed for pain in lower abdomen with H/o amenorrhea and Bleeding P/v and TVUSG showing tender adnexal mass or when medical treatment fails for ectopic.

Objective:

Dysmenorrohea, Dysparenunia & pelvic pain & Pain during defecation and Infertility are the presenting symptoms. Endometriosis is the commonest cause of Infertility during Laparoscopy. Pigmented & white fibrotic lesions are the two different varieties of lesions. Rectovaginal endometriosis is poorly detected during Laparoscopy leads to more than 2-3 Laparoscopy of infertility patient without positive result. Endometriosis needs to be well documented during Laparoscopy, as residual diseases leads to recurrence & Infertility. Lot of awareness needs to be generated among Doctors for its identification during Laparoscopy, right treatment & documentation during surgery, proper postoperative aggressive fertility treatment within nine months as it may reoccur after nine months & follow up. Most rewarding results are achieved following Laparoscopic surgery with pregnancy rate from 50 to 70% in different series in Rectovaginal with severe Endometriosis excision should be preferred over simple drainage for preventing reoccurrence. But if we feel that cystectomy dissection is too difficult & likely to destroy many normal ovarian follicles, we do drainage & bipolar fulguration of internal surface of chocolate cyst. Right cleavage & proper dissection of recto-vaginal nodule is necessary for her pain relief. With increased awareness it will be recognized more & more frequent during Diagnostic Laparoscopy. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. For frozen pelvis sometimes pre operative GnRh analog injection is used.



Benefits of Laparoscopy Surgery:

  1. Shorter Hospital stay.
  2. Earlier return to your routine work.
  3. Cosmetically vary small scar.
  4. Less pain after operation.
  5. Best fertility enhancement & Fertility results following Laparoscopy.
  6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

Pre-operative Check Lists:

  1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
  2. Specific Investigations for Infertility (Endocrine, Blood, Genetic Husband’s semen examination etc.) If the couple is infertile.
  3. Operation planned from 4th to 10th day of Menstrual Cycle.
  4. Special Bowel preparation with Peglac 6 hours prior to Surgery & preparation of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
Many patients undergo Laparoscopy as Day care procedure, returning home within 24-48 hours of surgery. (DAY CARE SURGERY)

Average Duration of Surgery:
For normal Laparoscopy procedure takes about 25 to 75 minutes. For complicated Endometriosis it may take 1-2 hours.

Average Blood loss during Surgery:
50-90 cc

Average time after operation to resume normal activities/work:
Within 24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed.
Uterus is anteverted and pushed forward with uterine manipulator and rectum is pushed behind & backward with rectal probe. Recto-vaginal area is dissected with sharp dissection with scissor and flushed to posterior uterine & posterior vaginal wall. Fibrotic part is excised. Suction & irrigation done with Ringer lactate and Haemostasis is achieved. Rectal injury is checked with flatus tube and pelvis filled with ringer lactate. Drain is kept.

Post-operative Course:

  • Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
  • Patient can take fluids 6-8 hours after laparoscopy & light food after 12 hours. She may feel little abdominal & shoulder pain after laparoscopy for 48 hours but it cam be relived with pain killer tabs.
  • Drain is removed on next day.
  • Most of the patients can walk normally without support and can take normal diet 10-12 hours after the laparoscopy.
  • She can be discharged on the next day of the operation.
  • Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
  • Patient can do her normal activity within 24 hours after laparoscopy.
  • Patient is advised to take antibiotics & analgesic tabs.
  • For 5 days following laparoscopy.
  • Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
  • Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

 

 

Diagnostic laparoscopy

PCOD Drilling
Endometriosis
Chocolate cyst
Ectopic Pregnancy
Rectovaginal Endometriosis
Ovarian Cyst
Dermoid Cyst
Laparoscopic Fibroid
Laparoscopic Tubal reversal
Laparoscopic Burch's procedure
Laparoscopy for T.O.Mass
Laparoscopic Adhesiolysis
Laparoscopic Vaginoplasty
Total Laparoscopic Hystrectomy
Laparoscopic Vault
(Post-hystrectomy) Repair
Laparoscopic Tubal Ligation
Laparoscopic prolapase repair with preserving uterus
Laparoscopic VVF Repair
Laparocopic Misplaced Cu-T removal
Endoscopic Training Centre