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Background: Deep infiltrating endometriosis (DIE) is a debilitating disease that affects women’s quality of life and reproductive function. In clinical practice women with deep infiltrating endometriosis are often misdiagnosed or have several surgeries with suboptimal outcomes. This might be explained by several factors, lack of awareness of the disease, underestimation of the extent of the disease pre-operatively and lack of experience in surgical skill. Treatment and diagnosis of DIE is done by laparoscopy. Surgery is complication prone. There seems to be an ongoing debate in the literature on the best technique in managing recto vaginal endometriosis. Objective: Firstly, to review the literature on pre operative modalities in mapping out the extent of the endometriosis, and plan surgery. And secondly, to look at the literature regarding what best surgical technique to use for optimal symptom relief and a lower complication rates. Conclusion: There seems to be a shift to more conservative surgery, with similar symptom relief and lower complication rates. There needs to be greater awareness of RVE among gynaecologist. Surgical experience, not ego should dictate the surgical intervention of a surgeon. At best these patients should be managed at specialized units.