Optimizing outcomes in laparoscopic segmental resection for bowel endometriosis

The aim of this study was to compare surgical outcomes of two laparoscopic techniques for bowel endometriosis and determine the optimal laparoscopic segmental resection technique with mesentery preservation.

This was a single-center, retrospective, two-arm cohort study. A total of 135 patients underwent colorectal segmental resection for endometriosis from January 2014 to January 2022 in the Gynecology Department at the Jinhua Maternity and Child Health Care Hospital. The enrollment inclusion criteria were as follows: nodule ≥3 cm in size, ≥50% circumference/stenosis, and >5 cm from anal verge. Outcomes of laparoscopic segmental resection (LscSgR) of endometriosis were compared to laparoscopic segmental resection of endometriosis with mesentery preservation (LscPR). All eligible patients were informed that different intestinal surgical procedures would be performed as deemed necessary by a gynecologic surgeon.

A total of 135 patients with bowel endometriosis were enrolled and surgically treated: 72 underwent LscSgR (Group A) and 63 LscPR (Group B). After a median follow-up of 4.8 years, 131 patients completed the questionnaire. Complications included pelvic encapsulated hydrops (2.90%), rectovaginal fistula (2.90%), and anastomotic stenosis (2.90%). The recurrence rates of deep endometriosis were 2.90% in Group A and 1.62% in Group B. LscPR demonstrated significantly better outcomes than LscSgR in terms of both low anterior resection syndrome incidence and bowel endometriosis symptom scores.

LscPR is an effective surgical treatment for bowel endometriosis. The initial findings from the current study suggest the potential for significant symptom improvement with a lower incidence of complications in patients undergoing LscPR for bowel endometriosis, but further validation in larger studies is warranted. The findings of the current study open new perspectives in relation to treatment of bowel endometriosis.