Intraoperative Proctosigmoidoscopy Enhances Safety in Bowel Endometriosis Surgery: Study

A new study published in the Journal of Minimally Invasive Gynecology revealed that intraoperative proctosigmoidoscopy is a feasible and valuable adjunct during surgery for Endometriosis involving the bowel. It may help refine intraoperative decisions and potentially reducing both short- and long-term complications.

Endometriosis is a chronic gynecological condition where the uterine lining grows outside the uterus, sometimes affecting the bowel. When bowel involvement occurs, surgical intervention may require careful resection of the affected intestinal segments. Since these procedures carry risks such as bleeding, leakage at surgical connection sites (anastomosis), and long-term bowel symptoms, intraoperative proctosigmoidoscopy can be performed during surgery to directly visualize the inside of the rectum and sigmoid colon.

This study from the Department of Gynecology at Kokilaben Dhirubhai Ambani Hospital analyzed 300 endometriosis surgeries performed during April 2022 and March 2025. Of these, 126 patients had bowel lesions. Most cases were treated using partial-thickness discoid excision or shaving techniques (100 patients). However, this research focused on the 26 patients who underwent deeper surgical procedures (18 full-thickness discoid excisions, 8 segmental bowel resections) and who also received intraoperative proctosigmoidoscopy at the end of surgery.

Among the 26 patients studied, the technique revealed 2 intraoperative issues at the surgical connection site where one case was bleeding and one case was leakage. The bleeding case was identified only through proctosigmoidoscopy and was not apparent through standard surgical inspection alone. This finding highlights the potential role of intraoperative proctosigmoidoscopy in identifying complications that might otherwise remain undetected until after surgery.

4 patients reported persistent constipation following surgery, while 2 experienced ongoing chronic pelvic pain. No cases of rectovaginal fistula was documented. No patients developed luminal narrowing of the bowel or reported symptoms like painful bowel movements (dyschezia) or painful intercourse (dyspareunia).

Overall, the findings of this study suggest that intraoperative proctosigmoidoscopy is both feasible and clinically useful as an adjunct procedure during bowel endometriosis surgery. By allowing surgeons to evaluate the bowel internally before concluding the operation, the technique may refine intraoperative decision-making and improve surgical outcomes. Further dedicated multicenter studies may be required to confirm these benefits and guide the development future surgical protocols.

Source:

Kulkarni, D. A. S., Khanna, D. R., Konda, D. K. R., & Mulchandani, D. M. (2026). Intraoperative proctosigmoidoscopy following bowel endometriosis surgery: A retrospective evaluation. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2026.03.006