7690 Association between Prior Surgery and Concomitant Conditions and Positive Pathological Confirmation of Endometriosis Lesions

Abstract

<h3>Study Objective</h3> To compare the association between prior surgical intervention and concomitant conditions and pathologically confirmed positivity rate of endometriosis lesions. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> University teaching hospital. <h3>Patients or Participants</h3> All women above 18 years-old who underwent laparoscopic surgery for endometriosis at a tertiary care hospital from October 2011 to October 2020 were screened for inclusion. Patients who underwent open surgery or whose primary indication for surgery was not endometriosis were excluded. Procedures performed by non-gynecologic surgeons were also excluded. A total of 401 cases were included in this study. Patients were classified according to whether prior surgery for endometriosis or prior hysterectomy was done, concurrent hysterectomy or bilateral oophorectomy were performed, and whether fibroids and adenomyosis were diagnosed. To examine differences in positivity rates of endometriosis lesions, patients were classified as having reached or not having reached 80% positivity in pathological confirmation. Chi-square and Fisher's exact tests were used to assess statistically significant differences. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The percentage of patients reaching 80% positivity on pathological confirmed endometriosis was lower in women who had undergone previous laparoscopy for endometriosis compared to surgery naïve women, 66.5% vs 76.5% respectively, (p=0.03). Additionally, a higher percentage of women who underwent concomitant hysterectomy (83.5% vs 68.8% for non-hysterectomy, p=0.005) or bilateral oophorectomy (92.7% vs 70.0% for non-oophorectomy, p=0.002) achieved 80% positivity. Although women who had an associated diagnosis of fibroids (79.7% vs 70.5%) or adenomyosis (76.4% vs 71.7%) were more likely to reach 80% positivity compared to undiagnosed women, these differences were not statistically significant (p>0.05). <h3>Conclusion</h3> Prior laparoscopic surgery for endometriosis might cause tissue changes that decrease the pathological positivity rate of endometriosis lesions. This is beneficial when discussing post-operative findings and pathological results with patients.