Deep pelvic endometriosis (DIE) with intestinal involvement requires complete excision of implants including bowel resection. We report our experience with minimally invasive treatment of DIE involving the intestine. Patients and methods: data from all patients undergoing surgery for endometriosis were prospectively entered in a database. We identified 26 consecutive patients (mean age 33 yrs) who underwent 30 laparoscopic procedures for DIE involving the bowel between 03/03 and 03/08. Analyzed data included age, previous history of endometriosis, previous pregnancies, previous surgery, BMI, operative time, intra/postoperative complications, length of stay, short and long term outcomes. Subjective evaluation of improvement after surgery (compared to previous) was assessed using VAS scale and validated questionnaires. Postoperative hormonal therapy was not given. Results: preoperative symptoms included dysmenorrhea (100%), constipation/diarrhea (77%), tenesmus (73%), rectal pain (69%), dyspareunia (50%), chronic pelvic pain (42%), rectal bleeding (35%) and bloating (69%). Nineteen patients had previous surgery (73%). Preoperative investigations included endorectal ultrasound, barium enema and/or colonoscopy and pelvic MRI. Four patients (15.4%) underwent combined laparoscopic and minilaparotomic approach, 17 patients (65.4%) laparoscopic approach and 5 patients (21%) vaginal approach assisted by laparoscopy. Management of bowel endometriosis included superficial serosal excision and/or implant disc excision (20 patients), bowel resection with anastomosis (4 patients), appendectomy (2 patients) in addition to treatment of all others implants. No intra-operative complications were observed. The conversion rate was 7.7%. Overall complication rate was 7.7% including a fascial hematoma requiring revision and a superficial wound infection. Length of stay averaged 5 +/- 3 days (range 2-13 days). Mean follow up was 2.4 yrs. Three patients with persistent pain and one with rectal bleeding presented recurrence during the follow-up and required further surgery. Subjective evaluation showed significant improvement in terms of dismenorrea, dyspareunia and chronic pelvic pain. At follow up no evidence of constipation/diarrhea, tenesmus, rectal pain or bleeding and bloating was observed. Questionnaire to evaluate the quality of life showed a significant improvement of anxiety, stress and depression. Four out of 10 of previously infertile patients became pregnant within 6 months after surgery. Conclusions: Minimally invasive management of DIE requires a multidisciplinary approach and is associated with a significant improvement of symptoms.