2141 Decision-Making Algorithms for the Right Surgical Approach in Bowel Endometriosis: The Experience of a Single Third-Level Referral Center on More Than 3000 Procedures

Study Objective to define a surgical decision making algorithm in order to be able to select the right tailored-treatment to the patient with deep infiltrating endometriosis (DIE) involving the bowel endometriosis considering experience and data of our center where more than 3000 procedures were performed. Design Retrospective data-analysis was performed in order to define a surgical decision-making algorithm. Setting Third-level Referral Center for endometriosis. Patients or Participants a total of 3040 patients with bower DIE underwent to laparoscopic procedures from 2004 to 2018. Interventions 2460 cases of segmental colorectal resection, 298 cases of disc excision and 282 cases of rectal shaving. Measurements and Main Results Management plan for bowel DIE treatment need to consider different aspects: individual and clinical factors, preoperative morphological characteristics, impact on quality of life and surgical observation. Asymptomatic patients do not require surgery and must be followed clinically. The first-line treatment for symptomatic women is medical therapy. Indication for surgery is limited to the risk of bowel obstruction, in case of medical treatment's failure and for infertile patients after in-vitro fertilization's attempts. Using a strategy prioritizing shaving, whenever possible, allows, the right analysis of the size and the degree of infiltration of the nodule. Disc excision should be indicated for residual rectal nodules 2.5 cm (effective size of the nodule after shaving), in cases of multiple lesions, more than 50% of circumferential involvement, deeper than the submucosal layer or in presence of bowel obstructive symptoms. Conclusion Pre-operative classification of patients considering clinical factors, symptoms, needs and desire, is mandatory in order to define the best therapeutic strategy and to taylor the surgical procedure to the patient.