Endometriosis Surgery May Warrant Referral. (Cul-De-Sac, Rectosigmoid Colon).

ORLANDO, FLA. -- Surgery for endometriosis that has invaded the cul-de-sac and rectosigmoid colon is exceedingly challenging and fraught with difficulty, five leaders in the field said at a meeting of the One Kilo Club.

"If you get in there and see massive lesions--if you do that as a living--do it. If you don't, close them up, and send them to someone who does," said Dr. Thomas Lyons, a gynecologic surgeon in Atlanta. It is twice as hard to reoperate on endometriosis of the bowel as it is to complete the surgery the first time around, he added.

Dr. Lyons spoke on the subject at the meeting held in conjunction with the 37th International College of Surgeons' North American Federation Congress. He shared ideas and techniques with four of his colleagues: Dr. Nicholas Kadar of Cranbury, N.J., Dr. Larry S. Sasaki of Shreveport, La., Dr. Charles Koh of Milwaukee, and Dr, Philippe Koninckx of Leuven, Belgium.

The physicians also agreed that endometriosis of this region is nearly impossible to predict preoperatively Most said that the lesions are rarely palpable, even in a vaginal-rectal examination, and that ultrasound examinations are virtually of no use. A few years ago, most specialists in endometriosis that involves the colon operated alone. The surgeons at the meeting now routinely work alongside general surgeons in these complex cases.

Dr. Lyons emphasized the importance of developing mutual respect. "If the only time you call a general surgeon is when you have problems, they are coming in looking for problems."

If, on the other hand, a gynecologic surgeon has a relationship with a general surgeon, he or she will be respectful when a problem arises. The bowel will have been ...