Histologic-Proven Recurrence of Endometriosis after Previous Ablation Vs. Excision Surgery

Abstract

<h3>Study Objective</h3> compare incidence of recurrence of endometriosis after previous ablation or excision surgery for endometriosis. <h3>Design</h3> retrospective study. <h3>Setting</h3> academic medical center. <h3>Patients or Participants</h3> all patients who underwent excision endometriosis surgery from January 2013 to December 2020 who had history of previous ablation or excision surgery for endometriosis either at study institution or outside institution. <h3>Interventions</h3> repeat excision surgery for endometriosis. <h3>Measurements and Main Results</h3> Of the 139 patients that met inclusion criteria, 47 had previous ablation and 92 had previous excision of endometriosis. Differences in baseline characteristics at time of repeat surgery between the two groups included age < 35 (59.6% vs. 41.3%, p=0.04), historical American Society of Reproductive Medicine (ASRM) stage of endometriosis (Stage 1-2: 76.6% vs. 43.5%; Stage 3-4: 23.4% vs. 54.3%, p<0.001), and history of previous hysterectomy (2.1% vs. 14.1%, p=0.026). Overall, 80.5% of patients were found to have histologic evidence of endometriosis on repeat surgery. For those without versus with recurrence, proportion of nulliparity (59.3% vs. 72.3%, p=.21), interval since prior surgery (mean months 42 vs. 41, p=0.07), number of surgeries for endometriosis prior to surgery of interest (mean 2.5 vs. 1.7, p=0.92), previous hysterectomy (7.4% vs. 10.7%, p=0.61) and postoperative hormonal suppression (63% vs. 56.2%, p=0.73) did not differ. Overall recurrence did not vary by type of previous surgery (82.9% ablation vs. 79.3% excision). However, for those with previous ASRM stage 1-2, recurrence incidence was higher if ablation was previously performed (84.8% vs. 63%, p=0.04). <h3>Conclusion</h3> Most women pursuing repeat surgery for endometriosis are found to have histologic evidence of endometriosis recurrence. Excision surgery has lower recurrence of endometriosis for patients with lower ASRM stage. Although possible that initial surgery undertreated pre-existing disease, these findings support excision surgery as the preferred surgical approach for treatment of endometriosis.