Surgical and clinical outcomes following colorectal surgery for bowel endometriosis: a single centre experience

OBJECTIVES: Deep bowel endometriosis (DE), a severe infiltrative form mainly affecting the rectum and sigmoid colon, often requires surgery. We compared conservative (shaving, full-thickness discoid resection) and radical (segmental resection) techniques for postoperative complications and pain reduction. MATERIAL AND METHODS: We retrospectively analyzed 91 consecutive patients who underwent surgery for colorectal deep endometriosis (November 2020-October 2024) at a single center. Patients received conservative (shaving or full-thickness disc resection) or radical (segmental resection) treatment. Complications were graded by Clavien-Dindo classification, and pain was assessed preoperatively and at 6 months using a visual analogue scale (VAS). RESULTS: Among 91 patients, 40 (44%) underwent conservative and 51 (56%) radical surgery. Clavien-Dindo grade III complications occurred in 19/91 (20.9%) with 6/40 (15%) patients in the conservative group and 13/51 (25.5%) in the radical group (p = 0.22). Bowel leakage rates were comparable, occurring in 10% (4/40) patients following conservative and in 6/51 (11.8%) following radical surgery (p = 0.405); one rectovaginal fistula occurred after radical surgery (1/51, 1.9%), none after conservative. No grade IV complications were recorded. Radical surgery had longer operative time (295 min, 95% CI 267-322 vs 201 min, 95% CI 184-217; p < 0.0001) and hospital stay (mean: 11.57 ± 10.96 days vs mean: 5.78 ± 4.2 days; p < 0.001). Pain scores decreased significantly in both groups (including dysmenorrhea, non-cyclic pelvic pain, dyspareunia, dyschezia; p < 0.001). CONCLUSIONS: Conservative and radical surgery provide comparable complication rates and pain reduction in deep bowel endometriosis. Radical procedures are linked to longer operative time and hospital stay, neither technique appears clearly superior.