Managing the aftermath: complications and outcome after colorectal resection for deep infiltrating endometriosis—insights from a certified surgical endoscopy center

Abstract Deep infiltrating endometriosis (DIE) often affects the bowel and may necessitate colorectal resection. While protective ileostomy can reduce complications, it carries relevant morbidity. This study evaluates endoscopic complication management and long-term outcome of patients treated at a certified surgical endoscopy and endometriosis center. All patients undergoing interdisciplinary surgery for DIE (2015–2024) were retrospectively included. Preoperative sigmoidoscopy and postoperative endoscopic evaluation of anastomoses were performed routinely. Surgical approaches included shaving, excision or resection with/without ileostomy. Surgical complications, such as anastomotic leakages and stenoses, were primarily managed endoscopically. 118 women (median age: 33 years) underwent surgery: rectal shaving (25%), sigmoid (6%) and rectal resection (69%). Median anastomotic height was 10 cm, 44% received a protective ileostomy. Anastomotic leakage (8%) and stenosis (9%) were successfully managed endoscopically. Recurrence requiring reoperation occurred in 41% after shaving vs. 27% after resection. Ileostomy reversal was achieved in all cases. Postoperative continence was acceptable (LARS median: 13). General health (EQ-5D-5 L: median 70) was good at a median follow-up of 75 months. 84% would choose surgical treatment again. Colorectal resection for DIE can achieve favorable long-term outcomes in a structured interdisciplinary setting. Proactive endoscopic management supports bowel continuity despite complications. Prospective studies are needed to validate outcomes and refine patient selection.