To review and evaluate clinical features of laparoscopic excision of deep infiltrative endometriosis (DIE) involving the bowel before and after the establishment of a multidisciplinary endometriosis board (MDRB).

Design:

Retrospective cohort study

Setting:

Tertiary medical center

Patients or Participants:

22 patients with pathologically confirmed bowel endometriosis were analyzed; 11 surgeries occurred before and 11 following the implementation of the board.

Interventions:

The multi-disciplinary review board was implemented in January 2023 and included abdominal radiologists, colorectal and minimally invasive surgeons. Patients with suspicion of DIE involving the bowel on MRI were discussed preoperatively.

Measurements and Main Results:

The average participant age was 37.7 years, with a mean BMI of 26.2 kg/m². Most lesions (81.8%) were located in the rectosigmoid area, 9.1% in the ileocecal area and another 9.1% in both. Preoperative colonoscopy rates dropped from 90.9% pre-MDRB to 18.2% post-MDRB. Differences in estimated blood loss (154.5 mL pre vs. 180 mL post), operative time (315.6 mins pre vs. 252 mins post), and length of hospital stay (2.18 days pre vs. 1.73 days post) were not statistically significant.

Among 20 patients with rectosigmoid lesions, mean maximum lesion lengths were similar pre and post-MDRB (2.15 cm vs. 2.20 cm). Shaving remained the most common resection method at 60%, with discoid resections increasing from 10% to 30%, and segmental resections decreasing from 30% to 10%. Maximum lesion lengths by resection type varied slightly: discoid lesions were stable at 3.0 cm, while segmental lesions decreased from 5.0 cm to 4.0 cm, and shaving lesions increased from 3.0 cm to 4.0 cm.

Complication rates improved post-MDRB, with 81.82% reporting no complications, up from 63.64%.

Conclusion:

The integration of a multidisciplinary endometriosis board has demonstrated notable improvements in the management of DIE involving the bowel, reducing complication rates, and refining surgical approaches. This approach highlights the benefits of specialized teamwork in complex endometriosis care.