Deep infiltrating endometriosis is a highly invasive form of endometriosis which leads to severe pelvic pain and infertility. The surgical approaches like conservative surgery and nerve‐sparing are a proven efficient way to manage this endometriosis type but which method is the best is still under question? The following study answers the question by determination of the best endometriosis management approach.

Conservative or Radical surgery for bowel endometriosis treatment is still questionable. The study aimed to assess the surgical results of disk resection and segmental resection for pain symptoms, fertility, and quality of life score among the females with colorectal deep infiltrating endometriosis.

A total of 134 consecutive patients suffered from deep infiltrating endometriosis of the rectosigmoid up to 25 cm from the anal verge between the period of March 2011 to December 2016 were going through disk resection or segmental resection. The outcomes were measured as per the Clavien‐Dindo classification.

The segmental resection was carried out in 102 and disk resection in 32 patients. Both groups exhibited similar complication rates, period of surgery, inconsistent hemoglobin level and mean hospital stay. The functional outcomes, fertility and pain symptoms of both groups presented no difference. The follow-up was successfully conducted among 112 patients. Both groups presented with the significantly enhanced quality of life and reduced pain symptoms. With an overall fertility rate of 63.4%, twenty-six infertile females became pregnant spontaneously and thirteen using in vitro fertilization. Without any meaningful difference between the groups, the overall complication rate noticed was eight in 134.

Both conservative surgeries with nerve‐ / vessel‐sparing segmental resection and disk resection lessen the pain with similar morbidity. Pregnancy rate is improved with surgery by both approaches.