Conservative surgical treatment of rectovaginal septum endometriosis

Between 1982 and 1991, we performed conservative operations on 11 women aged 23 to 39 years (mean 28 years) with extensive rectovaginal septum endometriosis. Before the intervention, severe deep dyspareunia was reported by 6 patients and moderate by 4, severe dysmenorrhea by 4 and moderate by 5, and severe acyclic pelvic pain by 2, moderate by 4, and mild by 1. The subjects underwent vaginoabdominal surgery with subtotal removal of the posterior vaginal fornix and excision of intraperitoneal endometriosis, with presacral neurectomy in 7 cases and low anterior rectal resection in 5. After a mean follow-up of 41 months, 6 women have no dyspareunia and 5 have mild discomfort, 4 have no dysmenorrhea, 3 have moderate and 4 mild menstrual pain, and 6 have mild acyclic disturbances. Three of nine infertile patients conceived. In selected young women wanting children, with pelvic pain symptoms unrelieved by medical treatment, a conservative vaginoabdominal surgical approach is feasible, and satisfactory therapeutic results can be obtained.