Laparoscopic shaving for colorectal endometriosis: a literature review

In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2024 · vol. 13(4) , pp. 1082–1085 · doi:10.18203/2320-1770.ijrcog20240821 · W4393315711
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AI-generated summary by claude@2026-06, 2026-06-12

Laparoscopic shaving is a feasible technique for most colorectal endometriosis nodules, offering low complication rates and comparable recurrence to bowel resection, and should be considered the primary surgical approach.

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This paper is a literature review on laparoscopic shaving for colorectal endometriosis, focusing on how preoperative radiologic assessment guides choosing shaving versus disc excision or rectal resection for symptomatic deep lesions. Across summarized evidence, shaving performed by experienced surgeons was reported as feasible in more than 95% of colorectal endometriotic nodules with low complication rates, and recurrence rates after shaving were described as comparable to those after bowel resection. A stated limitation is that the review emphasizes outcomes in the context of experienced operators and decision-making based on extensive preoperative imaging, which may affect generalizability to other settings. This paper is centrally about endometriosis — it reviews surgical technique selection and outcomes for laparoscopic shaving in colorectal endometriosis.

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Abstract

Colorectal endometriosis is one of the most challenging conditions to manage. Surgical treatment is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Preoperative radiological examination should be extensive to determine the appropriate surgery: laparoscopic shaving, disc excision or rectal resection. We demonstrated that in the hands of experienced surgeons, shaving technique is possible in more than 95% of colorectal endometriotic nodules, with low complication rates compared to resection. Shaving and bowel resection are associated with comparable recurrence rates. As shaving is indicated whatever the size of deep lesions, surgeons should first consider rectal shaving to remove deep bowel endometriosis. Bowel resection should only be performed in case of major rectal stenosis (>80%), multiple or posterior lesions and stenotic colorectal nodules.
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Laparoscopic shaving for colorectal endometriosis: a literature review DOI: https://doi.org/10.18203/2320-1770.ijrcog20240821Keywords: Colorectal endometriosis, Shaving, Complications, RecurrenceAbstract Colorectal endometriosis is one of the most challenging conditions to manage. Surgical treatment is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Preoperative radiological examination should be extensive to determine the appropriate surgery: laparoscopic shaving, disc excision or rectal resection. We demonstrated that in the hands of experienced surgeons, shaving technique is possible in more than 95% of colorectal endometriotic nodules, with low complication rates compared to resection. Shaving and bowel resection are associated with comparable recurrence rates. As shaving is indicated whatever the size of deep lesions, surgeons should first consider rectal shaving to remove deep bowel endometriosis. Bowel resection should only be performed in case of major rectal stenosis (>80%), multiple or posterior lesions and stenotic colorectal nodules. Metrics References Hib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, et al. Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. Int J Womens Health. 2020;12:35-47. Chou D, Perera S, Condous G. Shaving for bowel endometriosis. J Minimal Invas Gynecol. 2020;27(2): 268-9. Donnez O. Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases. J Clin Med. 2021;10(21):5183. Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril. 2017; 108(6):931-42. Donnez O, Donnez J. Deep endometriosis: The place of laparoscopic shaving. Best Pract Res Clin Obstet Gynaecol. 2021;71:100-13. Chen Y, Wang D, Guo C. Accuracy of Physical Examination, Transvaginal Sonography, Magnetic Resonance Imaging, and Rectal Endoscopic Sonography for Preoperative Evaluation of Rectovaginal Endometriosis. Ultrasound Q. 2019; 35(1):54-60. Bazot M, Gasner A, Ballester M. Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod. 2011;26:346-53. Mezzi G, Ferrari S, Arcidiacono PG. Endoscopic rectal ultrasound and elastosonography are useful in flow chart for the diagnosis of deep pelvic endometriosis with rectal involvement. J Obstet Gynaecol Res. 2011; 37:586-90. Koninckx PR, Timmermans B, Meuleman C, Penninckx F. Complications of CO2-laser endoscopic excision of deep endometriosis. Hum Reprod. 1996; 11(10):2263-8. Mohr C, Nezhat FR, Nezhat CH, Seidman DS, Nezhat CR. Fertility considerations in laparoscopic treatment of infiltrative bowel endometriosis. J Soc Laparo Endosc Surg. 2005;9(1):16-24. Seracchioli R, Ferrini G, Montanari G, Raimondo D, Spagnolo E, Di Donato N. Does laparoscopic shaving for deep infiltrating endometriosis alter intestinal function? A prospective study. Aust J Obstet Gynaecol. 2015;55(4):357-62. Donnez J, Jadoul P, Colette S, Luyckx M, Squifflet J, Donnez O. Deep rectovaginal endometriotic nodules: perioperative complications from a series of 3,298 patients operated on by the shaving technique. Gynecol Surg. 2013;10:31-40. Redwine DB, Wright JT. Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril. 2001;76(2):358-65. Donnez J, Nisolle M, Casanas-Roux F, Anaf V, Smets M. Laparoscopic treatment for rectovaginal endometriosis. An atlas of laser operative laparoscopy and hysteroscopy. UK: Pathenon Publishing; 1994:75-85. Reich H, McGlynn F, Salvat J. Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis. J Reprod Med. 1991; 36(7):516-22. Abo C, Moatassim S, Marty N. Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril. 2018;109(1):172-8. Abrão MS, Andres MP, Barbosa RN., Bassi MA, Kho RM. Optimizing Perioperative Outcomes with Selective Bowel Resection Following an Algorithm Based on Preoperative Imaging for Bowel Endometriosis. J Minim Invasive Gynecol. 2020; 27(4):883-91. Bonin E, Bridoux V, Chati R. Diverting stoma-related complications following colorectal endometriosis surgery: a 163-patient cohort. Eur J Obstet Gynecol Reprod Biol. 2019;232:46-53. Bourdel N, Comptour A, Bouchet P. Long-term evaluation of painful symptoms and fertility after surgery for large rectovaginal endometriosis nodule: a retrospective study. Acta Obstet Gynecol Scand. 2018; 97(2):158-67. Mohr C, Nezhat FR, Nezhat CH, Seidman DS, Nezhat CR. Fertility considerations in laparoscopic treatment of infiltrative bowel endometriosis. JSLS. 2005;9(1): 16-24. Roman H, Moatassim-Drissa S, Marty N, Milles M, Vallee A, Desnyder E, et al. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril. 2016; 106(6):1438-45. Meuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311-26. Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, et al. Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol. 2005;192(2):394-400. Seracchioli R, Raimondo D, Arena A, Zanello M, Mabrouk M. Clinical use of endovenous indocyanine green during rectosigmoid segmental resection for endometriosis. Fertil Steril. 2018;109(6):1135. Bar-Shavit Y, Jaillet L, Chauvet P, Canis M, Bourdel N. Use of indocyanine green in endometriosis surgery. Fertil Steril. 2018;109(6):1136-7. Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E , Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021;28: 453-66. Roman H, Milles M, Vassilieff M, Resch B, Tuech JJ, Huet E, et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol. 2016;215(6): 762.e1-9. Roman R, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Daraï E, et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod. 2018;33(1):47-57. Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod. 2010;25(8):1949-58. Afors K, Centini G, Fernandes R, Murtada R, Zupi E, Akladios C, et al. Segmental and discoid resection are preferential to bowel shaving for medium-term symptomatic relief in patients with bowel endometriosis. J Minim Invasive Gynecol. 2016;23(7): 1123-9. Jatan AK, Solomon MJ, Young J, Cooper M, Pathma-Nathan N. Laparoscopic management of rectal endometriosis. Dis Colon Rectum. 2006;49(2):169-74. Roman H, Hennetier C, Darwish B, Badescu A, Csanyi M, Aziz M, et al. Bowel occult microscopic endometriosis in resection margins in deep colorectal endometriosis specimens has no impact on short-term postoperative outcomes. Fertil Steril. 2016;105(2): 423-9. Badescu A, Roman H, Aziz M, Puscasiu L, Molnar C, Huet E, et al. Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel. Fertil Steril. 2016;105(2):430-4.

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