Teenagers, adolescents, endometriosis and recurrence: a retrospective analysis of recurrence following primary operative laparoscopy

Abstract

In this paper, we aim to describe the clinical features and treatment outcome following the laparoscopic treatment of endometriosis in teenagers and adolescents. This is a retrospective review of girls aged 21 and below who underwent operative laparoscopy for endometriosis. We identified two groups: (1) the EMAT group, being those who underwent their primary laparoscopic surgery under the Endometriosis and Minimal Access Therapy team (EMAT), and (2) the non-EMAT group, consisting of those referred to the EMAT team with recurrent symptoms following primary operative laparoscopy by other gynaecologists. Symptom recurrence and the need for re-operation was compared between the two groups. Twenty-eight girls, age range 15–21 years, were identified. All had pelvic pain unresponsive to the pill and non-steroidal anti-inflammatory drugs (NSAIDs). Most disease was atypical, with the uterosacral ligaments and ovarian fossae being the most common sites. The re-operation rate per surgical team at 24 months was 14.2% for the EMAT group vs. 42.8% for the non-EMAT group. All recurrences in the non-EMAT group coincided with the location of primary disease. Disease recurrence occurred most commonly in the uterosacral ligaments. Endometriosis in teenagers is mainly atypical and, in our series, commonly affects the uterosacral ligaments. Disease in this location is deeply infiltrating and is usually not amenable to electrocoagulation. We advocate disease resection to minimise recurrence.