Role of Laparoscopy in Endometriosis or Die (Deep Infiltrating Endometriosis)

DIE is a infiltration of endometriosis below the peritonium more than 5 mm It may be rectovaginal in 5 to 12 % most commonly rectum and sigmoid is involved multiple lesions can be seen at different side according to the involvement DIE can be classified into anterior DIE involving bladder posterior DIE, involving uterosacral ligaments vagina as well as intestines all these DIE can be diagnosed by TVS or MRI sensitivity of both are the same. The indications of the surgeries may be symptoms like dyspareunia, cyclical, hematuria. Aim of the surgery would be resolution of symptoms but adopting oncological principles of surgery. After proper surgical excision of the disease fertility can be improved. Incase, of rectovaginal endometriosis indications for surgeries may be symptomatic endometriosis and in those where medical therapy won’t show any response. The preferable way of dealing RV endometriosis would be shaving, full thickness excision segmental resection and anastomosis the complications of these surgeries can be fistula formation anastomotic leak. 2% conversion to lapratomy.