Nerve Preservation Improves Outcomes in Bowel Endometriosis

Preserving pelvic nerves during bowel endometriosis surgery reduces complications and improves postoperative function.

Key Points

Highlights: 

• Nerve-sparing laparoscopic resection (LscPR) demonstrates superior functional outcomes in bowel endometriosis.
• Lower complication rates compared to segmental resection, with comparable or improved symptom control.

Importance: 

• Surgical strategy in bowel endometriosis must balance radicality with preservation of pelvic nerve function.
• Nerve-sparing approaches may reduce postoperative dysfunction while maintaining disease control.

What’s done here:

• This is a retrospective single-center cohort study of 320 patients with bowel endometriosis.
• Four surgical techniques compared: 
  • Laparoscopic shaving resection (LscShR, n=108),
  • Laparoscopic discoid resection (LscDR, n=70),
  • Laparoscopic segmental resection (LscSgR, n=73), and
  • Laparoscopic nerve-sparing resection (LscPR, n=69)
• Median follow-up 4.6 years; outcomes include complications, recurrence, low anterior resection syndrome (LARS), Bowel Endometriosis Syndrome score (BENS) and rectal function tests.

Key results:

• Overall complication rates were highest in LscSgR (16.7%), statistifically significantly lower in LscPR (4.35%).
• Bowel endometriosis recurrence observed only inrecurred only in patients who had laparoscopic shaving resection (12.1%) and laparoscopic discoid resection (7.3%); absent in others.
• Deep infiltrating endometriosis recurrence was low and comparable across all groups.
• LscPR achieved best overall symptom improvement with highest BENS scores, and also had lower rates of LARS with better preservation of bowel function vs segmental resection.
• Rectal sensory and motor function significantly better preserved with LscPR vs LscSgR.

Strength and Limitations:

• Strengths are: large surgical cohort with long-term follow-up; direct comparison of multiple techniques; inclusion of functional outcomes beyond symptom scores.
• Limitations are: retrospective design with selection bias; procedure choice influenced by lesion characteristics and evolving surgical expertise; single-center experience limiting generalizability.

From the Editor-in-Chief – EndoNews

"This study addresses a central challenge in the surgical management of bowel endometriosis: how to achieve adequate disease clearance while preserving pelvic organ function. The comparison across multiple surgical strategies highlights an increasingly relevant principle—the extent of resection must be balanced against the functional cost of disrupting pelvic innervation and mesenteric integrity.

The findings suggest that nerve-sparing approaches can maintain symptom control while reducing postoperative morbidity, particularly functional bowel dysfunction. This aligns with a broader shift in endometriosis surgery from purely lesion-centered excision toward function-preserving, physiology-aware interventions. Importantly, the absence of increased recurrence with a less radical yet anatomically respectful approach questions the assumption that more extensive resection necessarily translates into superior long-term outcomes.

However, interpretation requires caution. Surgical selection in retrospective cohorts is inherently influenced by lesion characteristics, anatomical complexity, and surgeon expertise. These factors may confound direct comparisons between techniques and limit the generalizability of the results.

Taken together, this study contributes to the evolving concept that precision in endometriosis surgery is not defined solely by radicality, but by the ability to tailor intervention to both disease burden and functional preservation. Future prospective studies integrating standardized functional outcomes and anatomical mapping will be essential to define optimal surgical strategies."

Lay Summary

Laparoscopic nerve-sparing resection (LscPR) may offer an optimal balance between effectiveness and safety in the surgical management of bowel endometriosis, according to a study published in the International Journal of Women’s Health.

In a retrospective cohort of 320 women treated between 2014 and 2024, investigators led by Dr. Min Hu from Jinhua Hospital, Zhejiang University, China, compared four surgical approaches, including shaving, discoid, segmental, and nerve-sparing resection.

LscPR was associated with substantial symptom improvement and the most favorable overall functional outcomes, reflected by better Bowel Endometriosis Syndrome (BENS) scores.

Importantly, complication rates were markedly lower than those observed with segmental resection (4.35% vs 16.67%), while recurrence of bowel endometriosis was not observed in the LscPR group.

In contrast, recurrence occurred only after shaving and discoid resections, although overall recurrence of deep infiltrating endometriosis remained low across all groups.

These findings suggest that preserving mesenteric and neural structures during bowel surgery may reduce postoperative morbidity while maintaining disease control. However, as the authors note, the retrospective design and potential selection bias warrant cautious interpretation.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41835853/