Postoperative outcomes in intestinal endometriosis surgery: a decade of experience from a Brazilian referral centre

To evaluate 30-day postoperative outcomes following different surgical techniques for intestinal endometriosis. This retrospective observational study included women who underwent surgery for intestinal endometriosis diagnosed preoperative by imaging between 2014 and 2024 at a tertiary referral centre in Brazil. The surgical strategy—shaving, disc excision, or segmental colorectal resection—was selected based on lesion characteristics. Postoperative complications within 30 days were graded according to the Clavien–Dindo classification and compared between techniques. A total of 335 women were analysed. A minimally invasive surgery was performed in 99.7% of cases, with a conversion rate of 2.1%. The rectum (49.3%) and rectosigmoid junction (27.5%) were the most frequently involved sites. The main common colorectal procedures were rectosigmoidectomy (37.9%), shaving (23.3%), and disc excision (18.8%). Overall, 30-day postoperative complications occurred in 38 patients (11.3%; 95% CI: 8.2–15.1%). Of these, 22 patients (6.6%; 95% CI: 4.2–9.8%) developed complications after hospital discharge. Thirty-day complication rates differed significantly according to surgical technique ( p = 0.005), with lower rates after shaving and higher rates after disc excision and rectosigmoidectomy. Anastomotic leak occurred exclusively in patients undergoing bowel resection. Disc excision was more frequently associated with postoperative anal bleeding, whereas shaving demonstrated the lowest overall morbidity. Median length of hospital stays increased from 2 days after shaving to 3 days after disc excision and 4 days after rectosigmoidectomy ( p = 0.046). No postoperative mortality was observed. This study found low short-term morbidity and no mortality after surgery for intestinal endometriosis in a high-volume referral centre. Higher complication rates were observed after more extensive procedures, particularly disc excision and rectosigmoidectomy, although these differences likely reflect underlying disease complexity and patient selection rather than surgical technique alone. These findings are consistent with a tailored, lesion-adapted approach and highlight the importance of careful patient selection when interpreting comparative outcomes between surgical strategies.