Introduction: The aim of laparoscopic surgery in the treatment of endometriosis is to remove or destroy all visible endometriosis as well as to restore normal pelvic anatomy hoping to minimise pain and overcome subfertility. Clinical presentations of endometriosis are divided into three categories including peritoneal, ovarian, and deep infiltrating endometriosis (DIE). Due to its deep penetration to more than 5 mm beneath peritoneal surface, DIE can invade into vital organs such as bowel, bladder or ureters. As a result, it is considered the most difficult endometriosis to be removed.

Methods: To evaluate clinical manifestations and surgical outcomes of women undergoing laparoscopic bowel resection for DIE at Centre for Advanced Reproductive Endosurgery during January 2010 and December 2014 using retrospective chart review.Results: Mean age was 35.5 ± 4.8 years and mean BMI was 23.1 ± 5.0 kg/m2. Among 30 women, 70% were nulliparous, 43.3% had infertility problem, 16.7% had at least two unsuccessful IVF cycles, and 60% had previous history of operative laparoscopic for endometriosis. The most common presenting symptoms included dysmenorrhea (86.7%), dyschezia (80%), bowel motion fluctuation (76.7%), and dyspareunia (73.3%) respectively. With logistic regression, symptoms of dysmenorrhea (OR 4.2; 95% CI 1.58–11.14; p = 0.004) and dyspareunia (OR 4.5; 95% CI 1.52–13.30; p = 0.007) were strongly correlated with the clinical finding of rectovaginal nodule. Reports of DIE from imaging studies were significant predictors of rectal endometriosis. For surgical outcomes, segmental resection with re-anastomosis was carried out in 90% of patients, among which 73.3% were performed with ultra-low rectal resection. Median resected bowel length was 67.5 +94.5 mm. Distribution of endometriosis was demonstrated in rectum 96.7%, sigmoid 23.3%, appendix 10%, cecum 6.7%, and ileum 6.7%. Extent of endometriosis invasion on the bowel wall included 76.7% muscularis, 20% submucosa, and 3.3% mucosa. Median blood loss was 672 + 196 ml and median operative time was 180 + 40 minutes. There was only one case of leakage and one case of bleeding from anastomosis sites. Postoperative bowel dysfunction, including constipation and diarrhea, was as high as 90% while voiding difficulty occurred in only 30%. At 6 week follow-up, 90% of patients showed improvement in pain symptoms and 80% had better bowel function.Conclusion: Laparoscopic bowel resection is an effective surgical procedure for DIE. Postoperative symptom relief has been confirmed. However, it requires multidisciplinary approach. Long-term follow-up is mandatory for actual estimation of pregnancy and recurrence rates.