BACKGROUND: Colorectal resection is performed in a majority of @entity1 presenting with large @entity46 of mid and lower rectum; however, it may negatively and irreversibly impact postoperative rectal function. To avoid such unfavourable outcomes, we propose an original technique combining laparoscopic deep rectal shaving and transanal disc excision using a semi-circular stapler. METHODS: The video presents the procedure performed in a 29-year-old nullipara referred with a large endometriotic nodule infiltrating the lower rectum on more than 30  mm length. The first step is laparoscopic and involves deep rectal shaving performed using exclusively the plasma energy. Then, transanal excision of shaved area is performed, by placing traction parachute sutures in the middle and outside the shaved area. Their traction induces the prolapse of shaved area that is resected using a semicircular stapler. Insufflating the rectum with air checks the integrity of the staple line. RESULTS: Operative time was 210  min. Immediate postoperative outcomes were uneventful, and bowel movements were normal beginning with day 6. Our technique is suitable in large rectal nodules located up to 10  cm above the anus, infiltrating the rectum on up to 6  cm length, and these parameters are preoperatively assessed using MRI and computed tomography. To date, it was successfully carried out in 29 @entity1 with large deep @entity46 of the mid and lower rectum. @entity3622 was recorded in one @entity1 (3.6  %) and transitory @entity1494 in seven @entity1 (25  %). Digestive function assessment using standardized questionnaires revealed an overall improvement, without de novo anal continence troubles. Postoperative pregnancy rate was 78  % with a majority of @entity1 having conceived spontaneously. CONCLUSIONS: Based on our experience, we believe that our conservative technique is feasible and reproducible in large mid and lower @entity46 and might avoid the risk of unfavourable outcomes related to low colorectal resection.

Deep shaving and transanal disc excision in large XXXX of mid and lower rectum: the Rouen technique.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient'] @entity46 :: ('MESH:D004715', 'Disease') :: ['endometriosis', 'rectal endometriosis'] @entity1494 :: ('MESH:D001745', 'Disease') :: ['bladder dysfunction'] @entity3622 :: ('MESH:D012006', 'Disease') :: ['Rectovaginal fistula']
@entity46 :: (MESH:D004715,Disease) :: ['endometriosis']
