Pain Relief, Gastrointestinal Function, and Recurrence After Conservative versus Radical (Segmental Resection) Surgery for Bowel Endometriosis: A Prospective Cohort Study

Yunlei Cao, Yuqing Jiang, Ding Ding Department of General Gynecology, Obstetrics and Gynecology Hospital of Fudan University; Shanghai Key Laboratory of Reproduction and Development; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of ChinaCorrespondence: Ding Ding, Department of General Gynecology, Obstetrics and Gynecology Hospital of Fudan University; Shanghai Key Laboratory of Reproduction and Development; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of China, Tel +86-13917579570, Email dingdinggyn1208@163.comBackground: Surgery represents a primary treatment option in selected cases of bowel endometriosis (BE), particularly in patients with significant symptoms or those unresponsive to medical therapy, and effectively improves patients’ quality of life (QoL).Objective: This study compared postoperative clinical outcomes between conservative (shaving/disc excision) and radical (segmental resection) surgical approaches for bowel endometriosis, and provided supplementary real‑world evidence.Design: This prospective cohort study enrolled patients who underwent surgery for bowel endometriosis between February 2023 and September 2023.Settings: A university-affiliated hospital.Patients: A total of 33 patients were initially recruited; 2 patients were lost to follow-up, and 31 patients were finally included for analysis.Interventions: Patients underwent bowel lesion shaving, disc excision or segmental resection and anastomosis, with surgical strategies individualized according to disease conditions.Main Outcome: Postoperative outcomes included complication rates, improvement in clinical symptoms, recovery of gastrointestinal function, and postoperative recurrence rate.Measures: Patients were followed up at 6, 12, 18, and 24 months post-surgery. Gastrointestinal function was evaluated using the Gastrointestinal Quality of Life Index (GIQLI).Results: Consistent with previous evidence, both conservative and radical surgery yielded significant and comparable improvements in pelvic symptoms and QoL, with stable effects during the 2-year follow-up (all P > 0.05). Low complication and recurrence rates were observed in both groups.Conclusions: Both surgical strategies achieve favorable clinical benefits for bowel endometriosis. No obvious intergroup superiority was confirmed, and surgical selection should be individualized based on lesion characteristics.