Does age influence surgical technique in bowel endometriosis? A multicenter analysis of 1547 cases

To evaluate whether patient age influences the complexity of the surgical approach for bowel endometriosis, including the technique performed and the route of specimen extraction. Methods: Retrospective, multicenter observational study, set in tertiary referral hospitals in the state of São Paulo, Brazil. A total of 1,547 patients who underwent surgery for bowel endometriosis between 2016 and 2025. Interventions: Surgical management of bowel endometriosis using one of three techniques: shaving, discoid nodulectomy, or segmental resection. Specimen extraction was performed via Pfannenstiel incision or natural orifice specimen extraction (NOSE). Results: Clinical variables, surgical technique, specimen extraction route, complications (classified by Clavien-Dindo), and associated procedures were analyzed. The mean age was 37.8 years. Conservative techniques were more frequent, with shaving performed in 62.4% of cases. No statistically significant association was found between age and surgical technique (p > 0.05). Severe complications (grade ≥ III) occurred in 1.9% of cases, with no significant difference between age groups. The abdominal extraction route (Pfannenstiel incision) was more commonly used in patients under 35 years (OR 1.42; p = 0.01). Conclusion: Age did not influence the choice of surgical technique or the severity of complications but was associated with the route of specimen extraction, likely due to a higher rate of uterine preservation in younger patients.