How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study

TLDR

Deep endometriotic bowel lesions are commonly treated with segmental resection, yet the completeness of full‑thickness disc resection remains uncertain. The study aims to evaluate how completely full‑thickness disc resection removes bowel endometriosis. Sixteen women undergoing segmental bowel resection had pre‑resection nodulectomy, and histology assessed infiltration and surrounding fibrosis in the muscular layer. Full‑thickness disc resection was incomplete in ≥40% of cases, with 43.8% showing residual endometriosis in adjacent bowel wall and limited fibrosis around the nodule in incomplete resections.

Abstract

BACKGROUND: This study aims to evaluate the completeness of full thickness disc resection in the treatment of deep endometriotic bowel lesions. METHODS: This study comprised 16 women with bowel endometriotic lesions requiring segmental resection. For the purpose of the study, before intestinal resection, nodulectomy was performed. The presence of endometriotic infiltration in direct continuity with the removed nodule and the presence of fibrosis in the area surrounding the nodule were histologically evaluated. RESULTS: In seven out of 16 cases (43.8%; 95% CI, 19.8–70.1), endometriosis was found in the bowel wall adjacent to the site of nodulectomy; the infiltration was visible in the muscular layer in all cases. In cases of incomplete nodulectomy, the muscular layer of the bowel segment surrounding the endometriotic nodule contained limited or no fibrosis. CONCLUSIONS: Full thickness disc resection is not complete in ≥40% of women with bowel endometriosis. Our finding that fibrosis in the muscular layer, the main landmark during surgical resection, does not always surround bowel endometriotic lesions might explain why incomplete resection may occur.