Laparoscopic discoid resection in rectal endometriosis: When less is more

Laparoscopic discoid resection represents a conservative surgical alternative to segmental resection in the treatment of rectal deep infiltrating endometriosis (DIE). This technique allows excision of infiltrative lesions while preserving rectal continuity and minimizing postoperative morbidity. Despite its recognized benefits, its indication remains limited and its widespread adoption is hampered by technical challenges.

We describe a refined approach to laparoscopic discoid resection based on our experience with 25 patients operated on between August 2021 and November 2025. This retrospective descriptive technical series aims to standardize key operative steps, including systematic rectal mobilization, meticulous shaving of the anterior rectal wall, intraoperative reassessment of lesion dimensions and luminal involvement using a rectal dilator, and safe introduction and alignment of the circular stapler.

These steps enhance exposure, facilitate stapler positioning, and allow more accurate identification of suitable candidates for discoid resection. Preoperative imaging often overestimated the extent of rectal infiltration, whereas intraoperative reassessment enabled more precise evaluation and, in selected cases, allowed conversion from an initially more aggressive surgical strategy to conservative management. The systematic use of shaving reduced lesion volume and exposed muscular layers, while rectal dilator insertion before stapler introduction helped ensure luminal feasibility and avoid unintended circumferential resection.

Laparoscopic discoid resection, when standardized and appropriately indicated, offers a fertility-preserving, organ-sparing solution for selected patients with rectal DIE. The proposed technical refinements may improve safety, reproducibility, and broaden the applicability of this conservative approach, potentially reducing the need for more aggressive surgical interventions in this young population.