Intraoperative Proctosigmoidoscopy Following Bowel Endometriosis Surgery: A Retrospective Evaluation

To evaluate the effectiveness of intraoperative proctosigmoidoscopy in patients undergoing bowel endometriosis surgery DESIGN: Retrospective, single-centre observational study.

Department of Gynecology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India PATIENTS: Patients undergoing bowel endometriosis surgery and intraoperative proctosigmoidoscopy at the end of the intervention, from April 2022 to March 2025.

Description of findings at intraoperative proctosigmoidoscopy after bowel endometriosis resection.

Among 300 endometriosis surgeries, 126 involved bowel lesions: 100 partial thickness discoid excisions/shaving, 18 full-thickness discoid excision, and 8 segmental bowel resections. This study reports on the latter 2 groups (26 patients in total) who also underwent intraoperative proctosigmoidoscopy. In these 26 patients, findings included 1 case each of bleeding and leak at the anastomosis site (bleed identified only on proctosigmoidoscopy). Postoperatively, 4 patients reported persistent constipation, and another 2 had chronic pelvic pain. No rectovaginal fistulas or luminal narrowing or dyschezia/dyspareunia were observed.

Intraoperative proctosigmoidoscopy is a feasible and valuable adjunct to endometriosis surgery involving the bowel. It may refine intraoperative decision-making and has the potential reduce both short- and long-term complications.