Does age influence surgical technique in bowel endometriosis? A multicenter analysis of 1547 cases.

Objective:  To evaluate whether patient age influences the complexity of the surgical approach for bowel endometriosis, including the technique performed and the route of specimen extraction. Methods: Retrospective, multicenter observational study, set in tertiary referral hospitals in the state of São Paulo, Brazil. A total of 1,547 patients who underwent surgery for bowel endometriosis between 2016 and 2025. Interventions: Surgical management of bowel endometriosis using one of three techniques: shaving, discoid nodulectomy, or segmental resection. Specimen extraction was performed via Pfannenstiel incision or natural orifice specimen extraction (NOSE). Results: Clinical variables, surgical technique, specimen extraction route, complications (classified by Clavien-Dindo), and associated procedures were analyzed. The mean age was 37.8 years. Conservative techniques were more frequent, with shaving performed in 62.4% of cases. No statistically significant association was found between age and surgical technique (p > 0.05). Severe complications (grade ≥ III) occurred in 1.9% of cases, with no significant difference between age groups. The abdominal extraction route (Pfannenstiel incision) was more commonly used in patients under 35 years (OR 1.42; p = 0.01). Conclusion: Age did not influence the choice of surgical technique or the severity of complications but was associated with the route of specimen extraction, likely due to a higher rate of uterine preservation in younger patients.