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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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“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]
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“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.”
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“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.”
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“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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Koninckx, P. R., Nardone, C. D. C., Schonman, R., Corona, R., Betsas, G., & Ussia, A. (2008) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2008.07.010 · Cited by 8
Roman, H., Darwish, B., Schmied, R., Remorgida, V., & Tuech, J. (2016) · Journal de gynécologie, obstétrique et biologie de la reproduction. Supplément/Journal de gynécologie obstétrique et biologie de la reproduction · doi:10.1016/j.jgyn.2015.11.010 · Cited by 6
Self-citationRegarding “Pillars for Surgical Treatment of Bowel Endometriosis”
Darwish, B., & Roman, H. (2016) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2016.05.016 · Cited by 3
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Donnez, J., & Dolmans, M.-M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10051085 · Cited by 182
Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis †‡¶
Working group of ESGE, E., Keckstein, J., Becker, C. M., Canis, M. J., Féki, A., Grimbizis, G., Hummelshøj, L., Nisolle, M., Roman, H., Sarıdoğan, E., et al. (2020) · Human Reproduction Open · doi:10.1093/hropen/hoaa002 · Cited by 176
Self-citationDonnez, J., Taylor, H. S., Taylor, R. N., Akin, M. D., Tatarchuk, T. F., Wilk, K., Gotteland, J.-P., Lecomte, V., & Bestel, E. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.02.114 · Cited by 124
Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis
Bendifallah, S., Puchar, A., Vesale, E., Moawad, G., Daraï, E., & Roman, H. (2021) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2020.08.015 · Cited by 119
Self-citationHudelist, G., Aas‐Eng, M. K., Birsan, T., Berger, F., Sevelda, U., Kirchner, L., Salama, M., & Dauser, B. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13436 · Cited by 75
Metadata
- 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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