Journal of the European Society for Gynaecological Endoscopy


Colorectal endometriosis: ample data without definitive recommendations

G.N. Moawad 1,2, J.S. Klebanoff 3, N.Habib 4, S. Bendifallah 5

1 Department of Obstetrics and Gynecology, The George Washington University, Washington, DC;
2 The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC;
3 Department of Obstetrics and Gynecology, Main Line Health, Wynewood, PA;
4 Department of Obstetrics and Gynecology, Francois Quesnay Hospital, Mantes-la-Jolie, France;
5 Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hopitaux de Paris (AP-HP), Sorbonne University, France.


Colorectal endometriosis, shaving, disc excision, segmental resection

Published online: Mar 31 2021


The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynaecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centres dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.