Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection?
Open accessAbstract
Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Data show that shaving is feasible even in advanced disease. The risk of immediate complications after shaving and disc excision is probably lower than after colorectal resection, allowing for better functional outcomes. The presumed higher risk of recurrence related to shaving has not been demonstrated. For these reasons, surgeons should consider rectal shaving as a first-line surgical treatment of rectovaginal DE, regardless of nodule size or association with other digestive localizations. When the result of rectal shaving is unsatisfactory (rare cases), disc excision may be performed either exclusively by laparoscopy or by using transanal staplers. Segmental resection may ultimately be reserved for advanced lesions responsible for major stenosis or for several cases of multiple nodules infiltrating the rectosigmoid junction or sigmoid colon.
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The risk of recurrence is a time-dependent variable.
“while the risk of recurrence is logically a time-dependent variable [2].”
From Post-operative complications and recurrence rate after treatment of bowel endometriosis: Comparison of three techniques (2019) · cites this paper as [2]
Several studies and reviews suggest that discoid resection techniques and especially partial thickness discoid resection (ie rectal shaving) may confer lower postsurgical complication rates compared to segmental resection.
“There are, however, several studies and reviews suggesting that discoid resection techniques and especially partial thickness discoid resection (ie rectal shaving) may confer lower postsurgical complication rates compared to segmental resection.”
There is no real consensus on how to optimally treat colorectal endometriosis surgically.
“There is, so far, no real consensus on how to optimally treat colorectal endometriosis surgically, since the application of the main three techniques, namely, segmental colorectal resection, full thickness discoid resection (FTDR) and so‐called shaving, depends on various factors which may differ from unit to unit and surgeon to surgeon.”
Avoiding repeat surgery in case of recurrence of pain is even more important, as it is well known that this is often the source of severe complications.
“Avoiding repeat surgery in case of recurrence of pain is even more important, as it is well known that this is often the source of severe complications [123].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [123]
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Self-citationRegarding “Pillars for Surgical Treatment of Bowel Endometriosis”
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Self-citation
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Research works printed but not linked: 3
- [12]12. Koninckx PR, De Cicco C, Schonman R, Corona R, Betsas G, Ussia A. The recent article ''Endometriosis lesions that compromise the rectum deeper than the in- ner muscularis layer have more than 40% of the circumference of the rectum affected by the disease''. J Minim Invasive Gynecol 2008;15:774-5.
- [85]85. Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, et al. Computed tomography-based virtual colonoscopy: an ex- amination useful for the choice of the surgical management of colorectal endometriosis. Gynecol Obstet Fertil 2011;39:339-45.
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Recommendations for the surgical treatment of endometriosis Part 2: deep endometriosis †‡¶.
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Deep pelvic endometriosis: clinical features, diagnosis, and treatment - a comprehensive review
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Postoperative Assessment of the Quality of Life in Patients with Colorectal Endometriosis
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Self-citationBowel surgery for endometriosis: A practical look at short- and long-term complications
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Robotic Surgery for Severe Endometriosis: A Preliminary Comparative Study of Cost Estimation
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Self-citationRobotic assisted rectal disk excision: the 3-cm diameter cut off may be abandoned
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Self-citationSurgical treatment of colorectal endometriosis: an updated review
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Association between Endometriosis and Surgical Complications among Benign Hysterectomies
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Minimally invasive surgery for deep endometriosis
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- Authors
- Donnez, O., & Roman, H.
- Affiliations
- UCLouvain (BE)
- Hôpital Charles-Nicolle (FR)
- Corresponding author
- Donnez, Olivier
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 108
- Issue
- 6
- Pages
- 931-942
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2773190186
- Semantic Scholar
- f0630c7306ab8481cc40c722d27fa2e8adc40cc0
- Cited by
- 252
- References
- 95
- Citations by year
- 2026: 16 · 2025: 21 · 2024: 31 · 2023: 25 · 2022: 28 · 2021: 38 · 2020: 55 · 2019: 25 · 2018: 12 · 2017: 1
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Digital Access to Libraries (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- deep infiltrating endometriosis, rectovaginal endometriosis, rectal shaving, disc excision, bowel resection, laparoscopic surgery, postoperative complications, rectovaginal fistula, anastomotic leakage, endometriosis recurrence, timing of surgery, segmentectomy
- MeSH terms
- Clinical Decision-Making, Endometriosis, Female, Humans, Male, Laparoscopy, Postoperative Complications, Rectal Diseases, Risk Factors, Digestive System Surgical Procedures, Gynecologic Surgical Procedures, Vaginal Diseases, Treatment Outcome, Patient Selection
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