Design: Preliminary retrospective, descriptive analysis.

Setting: Surgical cases performed by a single surgeon at an academic institution from 2008-2023.

Patients or Participants: 43 patients undergoing excision of deep infiltrating colorectal lesions.

Interventions: We employ a novel technique that includes a running two-layer closure with sutures.

Measurements and Main Results: On exam, 32.56% (n=14) of patients had a rectal nodule, and 88.37% (n=38) had general nodularity. 34.88% (n=15) of patients had a colorectal lesion on MRI. True positive rate for nodularity on exam and rectal lesion on MRI was 88.37% and 78.95%, respectively. The median (25%ile, 75%ile) largest lesion dimension on MRI was 2.10cm (1.50, 3.10), on operative report 1.75cm (1.15, 2.00), and on pathology report 2.10cm (1.50, 2.50). The largest absolute lesion dimension was 4.7cm on MRI, 5cm on operative report, and 3.8cm on pathology report. The conversion rate to low anterior bowel resection (LAR) was 4.65% (n=2), both due multifocal nodularity. A composite complication rate was 6.98% (n=3) including only ileus (2.33%, n=1) and acute urinary retention (4.65%, n=2). Median length of stay was 1 day (1, 3), with 67.44% (n=29) discharged same day. Of those with infertility 27.27% had a clinical pregnancy within 2 years.

Conclusion: Most rectal lesions were <3cm, however discoid resection was performed for lesions up to 5cm. Conversion rate to LAR was 4.56%, and performed for multifocal lesions. Overall complication rate is lower than cited in the literature. For those with infertility, 27.27% had a clinical pregnancy within 2 years. Our novel technique for discoid resection with a two- layer suture closure produces improved outcomes as compared to current publications. These findings may inform best practice for management of colorectal endometriosis.