- Deep infiltrating endometriosis needs multidisciplinary excision.
- Cyclical bowel and bladder symptoms suggest deep disease.
- Specialist-centre surgery lowers recurrence.
What deep infiltrating endometriosis means
Deep infiltrating endometriosis (DIE) is defined as endometriotic tissue that penetrates more than 5 mm below the peritoneal surface. It typically involves the uterosacral ligaments, rectovaginal septum, bowel wall, bladder, or ureter. Around 20% of women with endometriosis have deep disease.
Recognising deep disease
Cyclical rectal bleeding, painful defaecation with periods, cyclical haematuria (blood in urine), deep pain with sex reproducibly in one location, and lower back or sciatic pain during periods all suggest deep disease. Bowel disease can present as bloating, urgency, or diarrhoea alternating with constipation.
Why surgery must be multidisciplinary
Complete excision of deep disease often requires a colorectal surgeon (bowel shaving, discoid or segmental resection), a urologist (for ureteric or bladder involvement) and an experienced gynaecologist working together on the same laparoscopy. This is what a BSGE-accredited centre in the UK — or an equivalent tertiary centre in Istanbul — provides. Fragmenting care between clinicians is the main reason recurrence rates rise.
Frequently asked questions
Will I need a bowel resection?
Only if disease infiltrates the bowel wall deeply; shaving or discoid excision is preferred where possible.
Can deep disease come back after complete excision?
Recurrence after complete excision in a specialist centre is around 10–15% at five years — much lower than after incomplete surgery.
Is the surgery keyhole?
Almost always. Open surgery is now rare and reserved for very advanced cases.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation