“Shaving vs. Resection”: How We Treat Bowel Endometriosis (And Avoid the Bag)
It is the diagnosis that sends most patients into a spiral of panic: Bowel Endometriosis.
You likely went to Google, typed in “bowel surgery for endometriosis,” and were immediately hit with terrifying images of colostomy bags (stomas) and major intestinal reconstruction. The fear is so intense that many women choose to live with excruciating pain—painful bowel movements, bleeding, and severe bloating—rather than risk surgery.
At ESSI, we want to replace that fear with facts. The reality is that permanent stomas are incredibly rare in expert hands. We treat the bowel using a “Ladder of Intervention,” always prioritizing the option that effectively removes the disease while doing the absolute minimum to the bowel itself.
Here is the difference between the three levels of treatment we use.
Level 1: Rectal Shaving (The “Peeling” Method)
The Concept: Think of the endometriosis lesion like a sticker on a piece of fruit. The goal is to remove the sticker without cutting into the fruit itself. In a “Shaving” procedure, we carefully peel the endometriosis nodule off the surface of the bowel wall, leaving the intestine underneath intact.
-
When we use it: This is our preferred method for lesions that sit on the surface or haven’t pushed too deep.
-
The Benefit: Because we aren’t cutting into the bowel, the recovery is much faster and the risk of complications is extremely low. At ESSI, this is our default approach whenever safe.
Level 2: Discoid Resection (The “Patch” Method)
The Concept: Sometimes, the “sticker” has gone a little deeper into the skin of the fruit. If we just peeled it, we might leave some disease behind. In these cases, we remove the nodule along with just the small, coin-sized patch of bowel wall attached to it.
-
When we use it: For single, deeper nodules that are still relatively small.
-
The Benefit: It allows us to remove the full depth of the disease without needing to remove a large section of the intestine. It is a “happy medium” that spares the majority of the organ.
Level 3: Segmental Resection (The “Section” Method)
The Concept: This is reserved for the most severe cases. If a nodule creates a blockage or wraps around the bowel, we may need to remove that specific segment of the intestine and reconnect the two healthy ends.
-
When we use it: We only do this when absolutely necessary to cure a blockage or severe obstruction.
-
The Benefit: It is the only way to resolve severe bowel dysfunction and prevent future emergencies in advanced cases.
Addressing the “Bag” Fear
The question everyone asks: “Will I wake up with a colostomy bag?”
In the vast majority of ESSI cases (Shaving and Discoid), the risk is nearly zero. Even with a Segmental Resection, a temporary stoma is rare and typically reserved for very specific, complex cases to let the bowel heal safely. It is almost never permanent.
Why Expertise Matters
Bowel endometriosis is dangerous territory for a general gynecologist. They often lack the experience to “shave” safely, so they either leave the disease behind (causing continued pain) or call in a general surgeon who might be too aggressive.
At ESSI, we have a Multidisciplinary Team. Our gynecologic excision specialists work side-by-side with expert colorectal/general surgeons like Dr. Joe Raccuia. This allows us to make the right call in real-time:
-
We have the finesse to Shave when possible.
-
We have the skill to Resect when necessary.
-
We have the judgment to know the difference.
Your bowel function is critical to your quality of life. Don’t let fear keep you in pain—just make sure you are in expert hands.
