Do I need a colorectal surgeon for bowel endometriosis surgery?

Sometimes, especially if imaging or exam suggests deeper rectal or sigmoid involvement and there is a real possibility that the bowel wall may need to be opened, repaired, or resected. Bowel endometriosis can range from superficial implants on the outer surface of the bowel to deep disease that infiltrates the muscular layers and narrows or distorts the lumen. The deeper it goes, the more important it is to have a team that can safely handle bowel entry, suturing, stapling, and anastomosis if needed. In most cases, a general surgeon or colorectal surgeon is required, unless your primary surgeon is a gynecologic oncologist or your team includes one. All three are credentialed in bowel surgery.

In many patients, bowel-type symptoms come from inflammatory pelvic disease and adhesions even without full-thickness bowel involvement, and surgery may be limited to careful excision off the bowel surface, or “shaving,” without requiring a formal bowel procedure. Ideally, the decision is made with pre-op mapping (often ultrasound and/or MRI) and a plan that matches your anatomy, so you’re not surprised in the operating room by an unanticipated higher-risk bowel step.

In our practice, we have a unique offering: Dr. Vasilev is a gynecologic oncologist who is trained and credentialed to perform bowel surgery. We plan bowel endometriosis surgery around safety and completeness, using robotic excision for precision, and we coordinate the right surgical partners when the imaging, exam, or history suggests a disc excision or segmental resection could be needed. For example, there may be evidence of other disease like diverticulosis or other bowel findings. If you tell us your symptoms and what your imaging shows (or if you’re unsure), our team can help you understand whether a colorectal surgeon should be involved from the start and what that means for recovery and outcomes.