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Background: Bowel endometriosis involves the rectum in most cases. In this setting, laparoscopic rectal resections with low colo-rectal anastomosis are frequently required and are associated with good symptomatic relief but with the risk for major complications. Discoid resections have been proposed in the treatment of small (<2.5cm) single endometriosic nodule of the rectum without bowel stenosis as an alternative to segmental resection. Methods: Between 2004 and 2009, 81 patients (median age 35 years) underwent laparoscopic excisions of endometriosis with full thickness discoid resections of bowel endometriosis using a circular stapler inserted transanally. 32 procedures were performed between 2004 and 2006 (early period) and 49 between 2007 and 2009 (late period). Perioperative and long-term outcomes were analyzed.Results: Dysmenorrhea, chronic pelvic pain, dyschesia, dyspareunia, rectal bleeding were present preoperatively in 100%,75%,78%,80%, 2.5% of cases, respectively. No laparoconversion was required and overall median operative time was 180 minutes with median blood loss of 100 ml. Median time of discoid resection was 15 minutes. Temporary ileostomy was required in one patient (1.5%). There was no mortality, overall morbidity was 16%. Median length of stay was 5 days. Rates of intra-abdominal haemorrhages, rectal bleeding, enteric fistula, blood transfusions and reoperation were 2.5%,6%,1.5%,6% and 6%, respectively. Rectal bleeding from the stapler line were successfully managed using conservative endoscopic management. At pathology, three patients (3.5%) showed a microscopic involvement of the surgical margin of the discoid resection by endometriosic tissue.There was a decrease of median operative time (220 vs 150 min,p<0.0001), blood loss (200 vs 130 ml,p=0.105), length of stay (6 vs 5 days,p=0.07), overall morbidity (28% vs 8%,p=0.017), haemorrhages (6% vs 0,p=0.07), rectal bleeding (12.5% vs 2%,p=0.06), blood transfusions (12.5% vs 2%,p=0.06) from early to late period reflecting an improved learning curve.Long-term follow-up data were available for 67 patients (83%) with a median follow-up was 41 months. Postoperative rates of dysmenorrhea, chronic pelvic pain, dyschesia and dyspareunia decreased to 30%, 24%, 22%, 13.5%, respectively (p<0.0001). In nine patients (13.5%) there was a diagnosis of endometriosis-recurrence, but only four (6%) underwent reoperation. The rate of bowel endometriosis recurrence was 1.5%.Conclusions: Discoid resection is a safe procedure for the treatment of single endometriosic nodule < 2.5 cm in size in the rectum. Rate of overall morbidity and specific bowel complications was acceptable, with a decrease over time reflecting a learning curve process. Long-term outcomes are satisfactory with significant improvements in symptoms and a very low rate of bowel endometriosis recurrence.