Bowel endometriosis: safe endoscopic excision of deep infiltrating extra-genital endometriosis

Abstract

The purpose of this film is to demonstrate the various surgical techniques for treatment of bowel endometriosis. Surgery is the cornerstone for treatment of bowel endometriosis in patients who are clinically symptomatic. The laparoscopic approach is the ideal mode of incision as it has been shown to be equally safe as open surgery and results in fewer intra-operative and post-operative complications. Several techniques are employed in particular circumstances and choice of technique varies depending on site of disease and level of bowel lumen involvement. Here, we demonstrate techniques including shaving of the lesion, disc excision of the lesion, segmental bowel resection, and appendectomy. Historically, segmental resection was advocated as the treatment of choice for endometriosis at all levels of the bowel. However, disc resection and the shave technique are safe, minimally-invasive treatment options that should additionally be considered. In addition, we also demonstrate surgical management of multi-organ involvement of deeply infiltrative endometriosis. Examples of foundational surgical techniques, including hydro-dissection and use of the CO2 laser, are shown as well. Techniques for surgical management of bowel endometriosis include shaving of the lesion, disc excision of the lesion, and segmental bowel resection. Shave excision and disc resection should be advocated whenever possible.