If we accept NOSE trans-anal colectomy, why not consider disc excision with bowel suturing for deep endometriotic nodules larger than 3cm?

OBJECTIVE: To present our preliminary experience with laparoscopic discoid excision for bowel endometriosis using hand-sewn bowel closure, without a circular transanal stapler. METHODS: This retrospective cohort study was based on prospectively collected data from Surgical Endoscopy Units in university-affiliated hospitals. Patients had deep endometriotic nodules involving the bowel, measuring >3 and ≤5 cm, and were scheduled for deep bowel shaving but considered unsuitable for standardized stapled discoid excision. Bowel shaving was initially attempted in all cases, and the decision to proceed to discoid excision was made intraoperatively. After excision, bowel closure was performed laparoscopically with a two-layer hand-sewn repair using 2-0 polyglycolic acid sutures. RESULTS: Ten patients were included. Mean duration of manual bowel suturing was 22 minutes (range, 18-35). Intraoperative complications were minimal. Time to first flatus ranged from 2 to 5 postoperative days, and oral feeding was delayed until bowel function returned. One patient developed severe febrile morbidity, successfully managed with antibiotics and parenteral nutrition. Follow-up ranged from 18 to 60 months. No severe complications, including anastomotic leakage, fistula, or major functional sequelae, occurred. Pain symptoms and quality of life improved in all patients. One patient developed recurrent bowel endometriosis and underwent segmental resection. Among four patients wishing to conceive, two achieved pregnancies, one spontaneously and one after in vitro fertilization; both delivered by caesarean section. CONCLUSION: Laparoscopic discoid excision with hand-sewn bowel closure may be a feasible conservative alternative for selected patients with larger bowel endometriotic nodules, potentially avoiding segmental resection.