Intraoperative Proctosigmoidoscopy Following Bowel Endometriosis Surgery: A Retrospective Evaluation

STUDY OBJECTIVE: To evaluate the effectiveness of intraoperative proctosigmoidoscopy in patients undergoing bowel endometriosis surgery DESIGN: Retrospective, single-centre observational study. SETTING: Department of Gynecology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India PATIENTS: Patients undergoing bowel endometriosis surgery and intraoperative proctosigmoidoscopy at the end of the intervention, from April 2022 to March 2025. INTERVENTIONS: Description of findings at intraoperative proctosigmoidoscopy after bowel endometriosis resection. MEASUREMENTS AND MAIN RESULTS: Among 300 endometriosis surgeries, 126 involved bowel lesions: 100 partial thickness discoid excisions/shaving, 18 full-thickness discoid excision, and 8 segmental bowel resections. This study reports on the latter 2 groups (26 patients in total) who also underwent intraoperative proctosigmoidoscopy. In these 26 patients, findings included 1 case each of bleeding and leak at the anastomosis site (bleed identified only on proctosigmoidoscopy). Postoperatively, 4 patients reported persistent constipation, and another 2 had chronic pelvic pain. No rectovaginal fistulas or luminal narrowing or dyschezia/dyspareunia were observed. CONCLUSION: Intraoperative proctosigmoidoscopy is a feasible and valuable adjunct to endometriosis surgery involving the bowel. It may refine intraoperative decision-making and has the potential reduce both short- and long-term complications.