Risk of Repeat Laparoscopy Following Surgical Diagnosis of Endometriosis: Effects of Hysterectomy, Oophorectomy, & Psychiatric Disease

Abstract

<h3>Study Objective</h3> To quantify rates of repeat laparoscopy following initial surgical diagnosis of endometriosis and investigate risk factors associated with repeat surgery. <h3>Design</h3> Retrospective chart review of patients with surgical pathology confirming endometriosis. This study met exemption criteria (45CFR 46.101b) following IRB review. <h3>Setting</h3> Academic tertiary hospital system. <h3>Patients or Participants</h3> Women ages 12-50 receiving a primary surgical diagnosis of endometriosis, Jan 2017 - June 2018. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Demographic variables, type of initial procedure (hysterectomy, oophorectomy, other laparoscopy), presence of psychiatric disease (defined by pre-determined clinical criteria) and repeat laparoscopy within 3 years of initial diagnosis. 136 patients met inclusion criteria. Initial surgeries included unilateral oophorectomy (8.1%), bilateral oophorectomy (3.7%), hysterectomy without oophorectomy (22.1%), hysterectomy with unilateral oophorectomy (5.9%), and hysterectomy with bilateral oophorectomy (6.6%). 53.7% underwent other laparoscopy not involving hysterectomy/oophorectomy. 66 patients (49%) met criteria for psychiatric disease. 15 patients (11%) underwent repeat laparoscopy. Comparing patients who underwent repeat laparoscopy with those who did not, there was no difference in age (35.7±5.9 vs. 37.9±11.1 years, respectively, p=0.46), BMI (26.2±7.0 kg/m² vs. 28.5±6.7 kg/m², p=0.22), or race/ethnicity (32% vs. 67% White, Chi-square p=0.55). There was no association between re-operation and psychiatric disease (RR=1.2, 95%CI: 0.48-3.06, p=0.79). Preservation of ≥1 ovary was not associated with re-operation (RR=0.87, 95%CI: 0.26-3.34, p=0.69). Uterine preservation may be associated with a greater risk of repeat laparoscopy, with a trend towards significance (RR=2.5, 95%CI: 0.98-6.40, p=0.09). <h3>Conclusion</h3> The 3-year repeat laparoscopy rate was 11%, consistent with prior literature. Psychiatric disease was not associated with re-operation. Uterine preservation at time of initial laparoscopy may be associated with re-operation, but ovarian preservation was not. While non-significant findings may be limited by underpowering due to a small sample size, these results may help inform counseling and surgical planning in the long-term management of endometriosis.