{"paper_id":"0f246d59-78b1-4e2e-b093-0f437f13e3d4","body_text":"Open Journal of Obstetrics and Gynecology, 2025, 15(10), 1748-1762 \nhttps://www.scirp.org/journal/ojog \nISSN Online: 2160-8806 \nISSN Print: 2160-8792 \n \nDOI: 10.4236/ojog.2025.1510148  Oct. 2 9, 2025 1748 Open Journal of Obstetrics and Gynecology \n \n \n \n \nClinical Presentation, Laparoscopic Findings, \nand Therapeutic Aspects of Endometriosis  \nin Patients Undergoing Laparoscopy  \nat the Yaoundé Gyneco-Obstetric  \nand Pediatric Hospital \nIsidore Tompeen1,2, Sandrine Kenmogne1,2, Junie Ngaha1,3, Véronique Mboua Batoun2,4,  \nEsther Meka1,2, Pascale Mpono2,5, Dohbit Sama1,2, Foumane Pascal1,6 \n1Department of Gynecology and Obstetrics, Yaoundé Gyneco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon \n2Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, \nCameroon \n3Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, \nCameroon \n4Department of Gynecology and Obstetrics, Yaoundé University Teaching Hospital, Yaoundé, Cameroon \n5Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital, Yaoundé, Cameroon \n6Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Ebolowa, Ebolowa, Cameroon \n \n \n \nAbstract \nIntroduction: Endometriosis is a chronic gynecological disease defined as the \npresence of endometrial tissue outside the uterine cavity. It affects approxi-\nmately 10% of women of childbearing age worldwide. It is a public health issue \ncharacterized by severe pain and infertility that negatively impacts the qual-\nity of life of affected patients. Laparoscopy plays a pivotal role in its diagnosis \nand surgical management. However, access to this minimally invasive tech-\nnique remains limited to a few specialized hospital centers, inc luding the Ya-\noundé Gyneco-Obstetric and Pediatric (YGOPH). This study aimed to evalu-\nate the clinical, laparoscopic, and therapeuti c aspects of endometriosis in pa-\ntients undergoing laparoscopic surgery at YGOPH. Methodology:  This was a \ndescriptive cross-sectional study with retrospective data collection over a five-\nyear period from January 2018 to July 2023, conducted in the Gynecology De-\npartment of YGOPH. We included patients with complete medical reco rds \nwho underwent laparoscopy and were diagnosed with endometriosis lesi ons. \nDisease staging was performed using the revised American Society of Repro-\nHow to cite this pap er: Tompeen, I., \nKenmogne, S., Ngaha, J., Batoun, V.M., \nMeka, E., Mpono, P., Sama, D. and Pascal, \nF. (2025) Clinical Presentation, Laparo-\nscopic Findings, and Therapeutic Aspects \nof Endometriosis in Patients Undergoing \nLaparoscopy at the Yaoundé Gyneco-Ob-\nstetric and Pediatric Hospital. Open Jour-\nnal of Obstetrics and Gynecology, 15, 1748-\n1762. \nhttps://doi.org/10.4236/ojog.2025.1510148 \n \nReceived:  August 21, 2025 \nAccepted: October 26, 2025 \nPublished: October 29, 2025 \n \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1749 Open Journal of Obstetrics and Gynecology \n \nductive Medicine (rASRM) classification. Data were analyzed using IBM SPSS \nStatistics version 26, and results were expressed as the mean, frequency,  and \npercentage. Results : Among 413 women who underwent laparoscopic s ur-\ngery, 71 were diagnosed with endometriosis lesions, accounting for 17.2 % of \ncases. The average age was 31.9 ± 5 years, and the average age at menarche was \n12.28 ± 2.08 years. Nulliparous women accounted for 61% of cases . The most \ncommon clinical symptoms were chronic pelvic pain (53%) and infertili ty \n(59.4%). Pelvic ultrasound was the most frequently performed imagin g study \n(53%). The primary surgical indications were infertility ( 34%), chronic pelvic \npain (19%), and ovarian cysts (17%). Regarding laparoscopy, superficial e n-\ndometriosis was the most prevalent phenotype (67%), with the ovary being the \nmost affected organ (75%). The uterosacral ligaments were the most fr equent \nlocation of deep lesions (65%). According to the rASRM, endometriosis  was \nsevere in 52% of cases. Surgically, endometriomas were systematically drained, \nfollowed by cyst wall excision in all cases. Superficial lesions were ablated b y \nfulguration in 40.5% of cases. Conclusion : The prevalence of endometrio sis \namong women undergoing laparoscopic surgery was 17.2%. This condition pri-\nmarily affected young, infertile women with chronic pelvic pain. Superficial en-\ndometriosis was the most common phenotype, with surgical management tai-\nlored accordingly. \n \nKeywords \nEndometriosis, Clinical Presentation, Laparoscopy, Treatment, YGOPH \n \n1. Introduction \nEndometriosis is defined as the presence of endometrial tissue outside the uterine \ncavity. It is a chronic gynecological disease that affects approximately 10% of women \nof childbearing age worldwide [1] . Often associated with severe pelv ic pain, dys-\nmenorrhea, dyspareunia, and infertility, endometriosis significantly impacts pa-\ntients’ quality of life and represents a considerable socioeconomic burden [2]. Man-\naging endometriosis is complex and involves medical and surgical approaches. \nSurgery is often recommended for severe or medically resistant cases. La paros-\ncopy, a minimally invasive surgical technique, is now considered the go ld stand-\nard for both diagnosis and treatment of endometriosis, offering advantages such  \nas smaller incisions, faster recovery, and less post-operative pain compared to lap-\narotomy [3].  \nIn the African context, particularly in Cameroon, endometriosis management \nfaces specific challenges. Diagnosis is often delayed due to limited public awar e-\nness, restricted access to  specialized diagnostic tools (experts on endometrios is, \nultrasound, and MRI), and cultural normalization of pelvic pain in wome n [4]. \nConsequently, patients often present at advanced disease stages with extensive, \ncomplex lesions. Furthermore, although laparoscopy is the preferred surgical ap-\nCopyright © 2025 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/   \n  \nOpen Access\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1750 Open Journal of Obstetrics and Gynecology \n \nproach for endometriosis, its availability in Cameroon is predominantly limi ted \nto major urban centers. Key barriers include: high equipment cost, shortage of \ntrained specialists, and insufficient surgical training progr ams in advanced lap-\naroscopic techniques [5]. As a referral center, the Yaoundé Gyneco-Obstetric and \nPediatric Hospital (YGOPH) plays a central role in managing complex gynecologi-\ncal conditions, including endometriosis.  \nThis study aims to describe the clinical, laparoscopic, and therapeutic aspects \nof endometriosis in women who underwent laparoscopic surgery at YGOPH. This \nresearch will improve our understanding of the disease’s specific characteristics in \nthe Cameroonian clinical context, identify challenges in diagnosis and surgical man-\nagement, and suggest ways to improve the care of women with endometriosis i n \nCameroon.  \n2. Methodology \n2.1. Study Design \nWe conducted a descriptive, cross -sectional study with  retrospective data collec-\ntion over a five-year period from January 2018 to July 2023 in the gynecology de-\npartment of YGOPH.  \n2.2. Study Population \nWe included all patients with complete medical records who underwent laparos-\ncopy during the study period and were diagnosed with endometriosis. For each case, \nsociodemographic, clinical, paraclinical, and intraoperative data were coll ected. \nWe used the revised American Society of Reproductive Medicine ( rASRM) score \nto stage the disease.  \n2.3. Data Analysis \nData were analyzed using IBM SPSS version 26 software, and results were pre-\nsented in tables and figures. Parameters of central tendency (mean and median) \nand dispersion (standard deviation and interquartile range) were used to describe \nquantitative variables. Qualitative variables were expressed as absolute or relative \nfrequencies.  \n2.4. Ethical Considerations \nThis study was approved by the ethics committees of the Faculty of Medicine and \nBiomedical Sciences at the University of Yaoundé 1 and YGOPH. The anonymity \nand confidentiality of the collected data were maintained.  \n3. Results \nDuring the study period, 413 patients underwent laparoscopy. Among them, 71 \nwere found to have endometriosis lesions, of whom seven patients were excluded \ndue to missing medical records. The participant flow chart is as follows ( Figure \n1).  \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1751 Open Journal of Obstetrics and Gynecology \n \n \nFigure 1 . Participant flow diagram. \n3.1. Prevalence of Endometriosis in Patients Undergoing  \nLaparoscopic Surgery \nOf the 413 patients who underwent laparoscopic surgery during the study period, \n71 had endometriosis lesions, representing a prevalence rate of 17.2%.  \n3.2. Sociodemographic Characteristics \nTable 1 . Sociodemographic characteristics of the patients.  \nCharacteristics N = 64 % \nAge   \nMeans ± SD 31.9 ± 5  \nRange 20 - 43  \n[20 - 24] 5 7.8 \n[25 - 29] 13 20.3 \n[30 - 34] 27 42.2 \n[35 - 39] 14 21.9 \n>40 5 7.8 \nParity   \nNulliparous 39 60.9 \nPauciparous 10 15.6 \nPrimiparous 14 21.9 \nMultiparous 1 1.6 \nMarital Status   \nSingle 40 62.5 \nMarried 24 37.5 \n\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1752 Open Journal of Obstetrics and Gynecology \n \nContinued  \nPlace of Residence   \nUrban 59 92.2 \nRural 5 7.8 \nEducation Level   \nSecondary 20 31.2 \nHigher Education 44 68.8 \nOccupation   \nCivil Servant 17 26.6 \nPrivate Sector 15 23.4 \nInformal Sector 7 10.9 \nStudent 14 21.9 \nUnemployed 11 17.2 \n \nThe age range was 20 to 43 years old, with an average age of 31.9 ± 5.0 years. The most \nrepresented age group was 30 to 34 years old (42.2%).  \nMost of the patients were nulliparous (60.9%), single (62.2%), highly educated \n(68.8%), and lived in urban areas (92.2%) (Table 1 ).  \n3.3. Clinical and Paraclinical Characteristics of Patients \nTable 2  summarizes the clinical characteristics of patients.  \n \nTable 2 . Clinical characteristics of the patients.  \nCharacteristics N = 64 % \nMenarche   \nMeans ± SD 12.28 ± 2.08  \nMedical History   \nCurettage 11 17.2 \nCesarian Section 2 3.1 \nMyomectomy 6 9.4 \nHysteroscopy 2 3.1 \nCervical Stenosis 1 1.6 \nInfertility   \nPrimary 22 34.4 \nSecondary 16 25 \nChronic Pelvic Pain   \nNon-cyclical 16 25 \nCyclical 18 28.1 \nDyspareunia 23 35.9 \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1753 Open Journal of Obstetrics and Gynecology \n \nContinued  \nDyschezia 1 1.6 \nMenorrhagia 3 4.7 \nAbdominal Distension 1 1.6 \nAdnexal Mass 19 29.7 \nUterosacral Ligament Induration 10 15.6 \nAbdominal tenderness 6 9.4 \nFixed Uterus 6 9.4 \nUmbilical Nodule 3 4.7 \nRetroverted Uterus 3 4.7 \nSurgical Indications   \nInfertility 22 34.4 \nChronic Pelvic Pain 21 32.8 \nOvarian Cysts 11 17.2 \nPost-myomectomy Laparoscopy 3 4.7 \nUnruptured Ectopic Pregnancy 3 4.7 \nUterine Fibroid 1 1.6 \nTubo-Ovarian Abscess 1 1.6 \nSuspected Ovarian Cancer 1 1.6 \nAdnexal Torsion 1 1.6 \n \nThe average age at menarche was 12.28 ± 2.08 years.  \nA history of curettage and myomectomy was found in 17.2% and 9.4% of cases, \nrespectively.  \nPatients were infertile in 59.4% of cases and reported chronic pelvic pain (53.1%), \nwhich was mostly cyclical. Dyspareunia was present in 35.9% of cases.  \nThe most common physical signs were the perception of an adnexal mass dur-\ning a vaginal examination (29.7%) and induration of the uterosacral ligame nts \n(15.6%).  \nThe main reasons for surgery were infertility (34.4%), chronic pelvic pain (32.8%), \nand ovarian cysts (17.2%).  \nTable 3  summarizes the paraclinical characteristics of the patients.  \nSerum CA 125 testing was requested for nine patients (14%) as part of the inves-\ntigation of an ovarian cyst. The test results were elevated in more than three-quar-\nters of the cases.  \nPelvic ultrasound was the most commonly performed morphological examina-\ntion (53.1%). The main ultrasound finding was ovarian cysts (61.8%), and endome-\ntriosis was suspected in three patients. Kissing ovaries were identified on ultrasound \nin two patients.  \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1754 Open Journal of Obstetrics and Gynecology \n \nTable 3 . Paraclinical characteristics of the patients.  \nCharacteristics N = 64 % \nCA125 Level 9 14 \nElevated CA125 7 10.9 \nPelvic Ultrasound 34 53.1 \nOvarian Cyst 21 32.8 \nKissing ovaries 2 3.1 \nAscites 1 1.6 \nPelvic MRI 11 17.2 \nRetrocervical Endometriosis 5 7.8 \nKissing ovaries 2 3.1 \nAdenomyosis 2 3.1 \n3.4. Clinical and Intraoperative Characteristics of Patients \nTable 4  summarizes these characteristics.  \nSuperficial endometriosis lesions were the most frequent (67.2%).  \nPelvic adhesions were present in 84.4% of cases.  \nThe ovary was the most commonly affected organ (75%), followed by the utero-\nsacral ligaments (45.3%).  \nThe most common primary lesions of superficial endometriosis were blue lesions \n(34.4%).  \n \nTable 4 . Characteristics of Endometriosis Lesions.  \nCharacteristics N = 64 % \nEndometriosis Phenotype   \nSuperficial Endometriosis 43 67.2 \nEndometrioma 34 53.1 \nDeep Infiltrating Endometriosis 34 53.1 \nSuperficial Endometriosis Appearance   \nBlue 22 34.4 \nRetraction 15 23.4 \nStellate Lesion 9 14 \nRed 8 12.5 \nCystic Nodule 7 10.9 \nWhite 5 7.8 \nBlack 3 4.7 \nHypervascularization 3 4.7 \nBrown 1 1.6 \nYellow 1 1.6 \nEndometrioma Location   \nLeft Ovary 7 10.9 \nRight Ovary 10 15.6 \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1755 Open Journal of Obstetrics and Gynecology \n \nContinued  \nBilateral 17 26.6 \nDeep Infiltrating Endometriosis Sites   \nUterosacral Ligaments 22 34.4 \nTorus Uterinum 10 15.6 \nRectovaginal Septum 12 18.7 \nRectum 1 1.6 \nOverall Affected Organs   \nSigmoid Colon 2 3.1 \nAppendix 2 3.1 \nRectum 4 6.3 \nBladder 4 6.3 \nDiaphragm 5 7.8 \nOvarian Fossa 5 7.8 \nPouch of Douglas 7 10.9 \nAbdominal Wall 10 15.6 \nRectovaginal Septum 12 18.7 \nTorus Uterinum 14 21.9 \nFallopian Tube 16 25 \nUterus 21 32.8 \nUterosacral Ligaments 29 45.3 \nOvaries 48 75 \nAdhesions (According to AFS Classification) 54 84.4 \nType A (Filmy) 11 17.2 \nType B (Dense Avascular) 44 68.7 \nType C (Opaque) 16 25 \n \nEndometriomas were bilateral in half of the cases (26.6%). When unilateral, the \nright side was most commonly affected.  \nThe uterosacral ligaments were the most common site of deep endometriosis le-\nsions (64.7%).  \nFigure 2  illustrates the distribution of endometriotic lesions based on their se-\nverity according to the rASRM classification.  \n \n \nFigure 2 . Revised American Society of Reproductive Medicine (rASRM) classification of \nendometriosis.  \n\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1756 Open Journal of Obstetrics and Gynecology \n \nAccording to the revised classification of the American Society of Reproductive \nMedicine (rASRM), most patients (51.6%) had severe endometriosis.  \nTable 5  summarizes the surgical procedures per formed to treat endometriotic \nlesions.  \n \nTable 5 . Surgical management of endometriotic lesions.  \nCharacteristics N = 64 % \nAdhesiolysis 54 84.4 \nComplete Adhesiolysis 45 83.3 \nIncomplete Adhesiolysis 9 16.7 \nEndometrioma Management 34 53.1 \nCyst Drainage 34 100 \nCyst Wall Excision 34 100 \nSuperficial Endometriosis Management 37 57.8 \nAblation (Fulguration) 15 40.5 \nExcision 12 32.4 \nCombined (Fulguration + Excision) 10 27.1 \nDeep Infiltrating Endometriosis Management   \nRetrocervico-Rectal Shaving 12 18.7 \nResection of Uterosacral Ligaments 22 34.4 \nAdditional Procedures   \nAppendectomy 1 1.6 \nUmbilical Nodulectomy 3 4.7 \nTuboplasty (Fimbrioplasty/Salpingostomy) 30 46.9 \n \nAdhesiolysis was completed in the majority of cases (83.3%).  \nEndometriotic cysts were systematically drained, followed by cyst wall excision \nin cases.  \nThe most common procedure for superficial lesions was ablation by fulguration \n(40.5%).  \nResection of the uterosacral ligaments was the main procedure for deep lesions.  \nRetro-cervico-rectal shaving was performed for retro-cervico-rectal lesions.  \n4. Discussion \nThe main objective of this paper was to study the clinical , laparoscopic, and ther-\napeutic aspects of endometriosis in women undergoing surgery at the YG OPH. \nMore specifically, the aim was to determine the frequency of endometriosis in the \nstudy population, to describe the sociodemographic, clinical, and para -clinical \ncharacteristics of the participants, to identify the different indications for laparos-\ncopy, and to report on intraoperative findings and surgical procedures. The main \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1757 Open Journal of Obstetrics and Gynecology \n \nlimitations of our study were the absence of anatomopathological confirmation of \nendometriosis. In 2022, using histopathology as the gold standard in the diagnosis \nof endometriosis, Gratton et al. [6] found that sensitivity for laparoscopic visuali-\nzation was 90.1% (95% CI : 81.0 - 95.1), specificity was 40%  (95% CI: 23.4 - 59.3), \nwhile positive and negative predictive values were 81.0% (95% CI: 71.0 - 88.1) and \n58.8% (95% CI: 36.0 - 78.4) respectively; and the accuracy was 77.1% (95% CI: 67.7 - \n84.4). In fact, very few files provided this information, which could be explained \nby patients not performing the anatomopathological examination or not report-\ning the results in the files at the post-operative appointment. Excluding cases with-\nout histological confirmation would have drastically reduced our sample si ze. \nHowever, it is important to remember that according to the recent recommenda-\ntions of the European Society of Human Reproduction and Embryology [7] , a \nnegative histology result does not entirely exclude the diagnosis of endometriosis. \nThus, in our study, we considered the visual diagnosis of endometriosis lesions at \nlaparoscopy.  \nThe overall prevalence of endometriosis among our study population was 17.2%. \nThis frequency is lower than the 48.1% found by Fawole \net al. in 2015 [8] and the \n62% found by Janssen et al. in 2013 [9] in Nigeria. The studies carried out by these \nauthors concerned a population with chronic pelvic pain or infertility. In fact, 45 \nto 82% of women with chronic pelvic pain and 2.1 to 78% of infertile women have \nendometriosis [10] [11]. In 2016, Prescott et al . [12] found a frequency of 6 %. \nIndeed, their study excluded infertile women. In Cameroon, in 2007, Mboudou et \nal. [13] found that 13.5% of women undergoing laparoscopic surgery for infertility \nhad endometriosis. These disparities can be explained by the heterogeneity of the \nselection criteria for the various studies and the methodology used. With the de-\nvelopment of endoscopic surgery in Sub-Sahelian Africa over the last few decades, \nwe can see that endometriosis is no longer an uncommon pathology in black Af-\nrican women.  \nThe mean age of the participants was 31.9 years (±5 years), with extremes of 20 \nand 43 years. These results are similar to those found in the African literature [8 ] \n[13]-[16]. Indeed, endometriosis is a pathology of young women of childbearing \nage. Single women represented 68% of our sample, while some authors [13 ] [14] \nfound a predominance of married women. The mean age at menarche was 12.28 ± \n2.08 years. Early menarche, defined as occurring at an age of 11 or 12 years or younger, \ndepending on the author, is associated with a higher risk of endometriosis [17]  \n[18]. Nulliparous women were the most represented group (61%), with only one \nparticipant being multiparous. Existing studies [14] [19] found a predominance of \nnulliparous women. Endometriosis is recognized as a cause of infertility through \nseveral mechanisms, including impaired folliculogenesis, poor oocyte quality, im-\npaired ovarian reserve, anatomical changes due to adhesions, a lack of exposure to \nsexual activity in women with chronic pain, and local proinflammatory factors, which \nreduce implantation rates and promote early abortion.  \nIn our study, patients’ main complaints were infertility (61%) and chronic pel-\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1758 Open Journal of Obstetrics and Gynecology \n \nvic pain (53%), which was most often cyclical. Pelvic pain and/or infertility are the \nprimary manifestations of endometriosis. These findings corroborate those of sev-\neral authors [8] [9] [13] [14] [16], who have shown that chronic pelvic pain and \ninfertility are the primary manifestations of endometriosis. The majority of pa-\ntients have normal physical findings, and the perception of an adnexal mass on \nvaginal examination was the most frequently detected physical sign (30% of par-\nticipants). This could be explained by the fact that our study included patients \nwith various clinical suspicions and operative indications. This makes searching \nfor physical signs specific to endometriosis suboptimal. Additionally, clinical find-\nings differ depending on whether they are sought during or outside of menstrua-\ntion. It should be noted that these signs are more visible during menstruation. \nThree of our patients presented with umbilical nodules, which are a s ign of cuta-\nneous endometriosis. The clinical manifestation of cutaneous endo metriosis de-\npends on the hormonal environment and is often associated with catamenial hem-\norrhage [20].  \nSerum Cancer Antigen 125 (CA 125) essays were performed by 14% of parti c-\nipants, with elevated levels found in over three-quarters of cases (77.8%). In 2012, \nSzubert \net al. [21] in Poland also found higher serum CA 125 levels in women with \nendometriosis. CA 125 can be used to improve diagnostic accuracy for endome-\ntriosis, and to assess the efficacy of surgical treatment and the progression towards \nmalignant transformation. However, the sensitivity of CA 125 alone is unsatisfac-\ntory, because elevated levels are seen in several physiological or pathological situ-\nations, such as ovulation, menstruation, ovarian cysts, pelvic infections, and can-\ncers of the ovary, pancreas, and lungs [22] [23].  \nA pelvic ultrasound was the most common morphological examination, performed \non 34 out of 64 patients (53.1%). Potential reasons to explain this low rate are direct \nreferral for emergent laparoscopy based on clinical presentation or patient finan-\ncial barriers. The main ultrasound finding was the presence of ovarian cysts (60%). \nThese results are consistent with those of Bilkissou \net al. [14], who found that 69.8% \nof patients underwent pelvic ultrasounds, with endometriomas being the primary \nfinding in 25.3% of cases. Pelvic ultrasound is accessible and is often used as a first-\nline procedure for pelvic gynecological diseases, including endometriosis. Moreo-\nver, endovaginal ultrasound has a sensitivity of 81% - 84% and a specificity of 90% - \n97% for diagnosing endometrioma [24]. A pelvic MRI was performed on 11 p a-\ntients (17%). Most of them showed deep endometriosis lesions. The sensitivity \nand specificity of MRIs for diagnosing and evaluating deep endometriosis lesions \npreoperatively are 88% and 99% [25] [26], respectively. However, the high cost of \nthis examination and the limited number of radiologists who specialize in endo-\nmetriosis may restrict its use.  \nThe main indications for surgery were infertility (34.4%), chronic pelvic pain \n(32.8%), and ovarian cysts (17.2%). In 2018, Hemmert \net al. [27] in the USA found \nthat the main indications were pelvic pain (63%), pelvic masses (1 4%), and men-\nstrual irregularities (10%). Infertility accounted for only 4%. Schliep et al. [19] also \nfound pelvic pain (62.2%), pelvic masses (12.8%), menstrual irregularities (8.8%), \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1759 Open Journal of Obstetrics and Gynecology \n \nand infertility (7.4%). These differences may be explained by the fact that all of \nthese studies included patients who had undergone laparoscopy for various rea-\nsons and for whom endometriosis lesions had been identified. The ovary was the \nmost affected organ (75%). Mboudou et al. [13] and Ajani et al. [15] also fou nd \nthe ovary to be the most affected organ in 35.8% and 58.8% of cases, respectively. \nSuperficial endometriosis lesions were the most frequent (67.2%). These resu lts \ndiffer from those of Bilkissou et al. [14], who found endometriomas (22.9%) and \nadhesions (14.5%). According to the rASRM classification, most of our patients  \n(51.6%) had severe endometriosis. Chapron et al. [28] in France in 2003 found mild \nendometriosis in most cases (38.1%). This difference may be explained by the fact \nthat their study only included patients with deep endometriosis lesions, whereas \nthe rASRM classification is not the most suitable for deep endometriosis, as it does \nnot take into account the involvement of sites such as the uterosacral lig aments, \nvagina, rectum, and bladder. Its scoring system prioritizes adhesions and ovarian \ndisease, thereby underrepresenting the functional impact of deep infiltrating nod-\nules. \nThe type of surgical treatment depends on the clinical form of endometriosis and \nthe number and location of the lesions. The most common procedure for treating \nsuperficial endometriosis lesions was ablation by fulguration. Ablation is indeed \na destructive technique recommended for treating superficial endometriosis lesions; \nhowever, the main drawback is the thermal damage associated with the diffusion \nof heat laterally and at depth. The endometrioma was systematically drained, fol-\nlowed by shell excision in 82% of cases. Exeresis of the cyst is associated with a lower \nrisk of recurrence than ablation. However, a greater or lesser portion of ovarian tis-\nsue may be removed, especially in endometriomas larger than 60 mm [29]. Surgery \nfor deep nodules most often involved total resection of the nodules (68%). This aligns \nwith the literature [29] [30].  \nSurgery should be considered only in patients with symptoms that do not respond \nto medical treatment and significantly impact the quality of life [31] . The current \nrecommendations for the management of endometriosis suggest medical therapy \nas the first line, including combined hormonal contraceptives and progesterone. \nThe second line consists of Gonadotropin-releasing hormone (GnRH) agonist, GnRH \nantagonist, and aromatase inhibitors [31].  \n5. Conclusion \nThis study highlights the clinical, laparoscopic, and therapeutic aspects of endo-\nmetriosis among women undergoing surgery at the Yaoundé Gyneco-Obstetric \nand Pediatric Hospital (YGOPH). The prevalence of endometriosis in our popu-\nlation was 17.2%, with infertility (59.4%) and chronic pelvic pain (53%) as the \npredominant symptoms. Sociodemographic findings align with existing literature, \nemphasizing endometriosis as a condition affecting young, predominantly nullip-\narous women of reproductive age. Despite the absence of routine h istopatholog-\nical confirmation, laparoscopic visualization remained a reliable diagnostic tool,  \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2025.1510148 1760 Open Journal of Obstetrics and Gynecology \n \nconsistent with recent ESHRE guidelines. Imaging modalities such as pelvic ultra-\nsound and MRI proved valuable, though accessibility and cost limit MRI’s wid e-\nspread use in our setting. Surgical management, tailored to lesion type and sever-\nity, predominantly involved fulguration for superficial lesions and cyst excisio n \nfor endometriomas, reflecting global standards. The study underscores the grow-\ning recognition of endometriosis in Sub -Saharan Africa, driven by advance s in \nendoscopic surgery. However, challenges persist, including limited diagnostic re-\nsources and heterogeneity in clinical presentation. Future efforts should prioritize \nmultidisciplinary approaches, standardized protocols, and increased awareness to \noptimize early diagnosis and treatment, ultimately improving quality of life for af-\nfected women. To enhance clinical outcomes in our region, we recommend the de-\nvelopment and implementation of standardized diagnostic and treatment protocols \nfor endometriosis. \nConflicts of Interest \nThe authors declare no conflicts of interest regarding the publication of this paper.  \nReferences \n[1] Giudice, L.C. (2010) Endometriosis. New England Journal of Medi cine, 362, 2389-\n2398. https://doi.org/10.1056/nejmcp1000274 \n[2] Peter, A.W., Adamson, G.D., Al -Jefout, M., Becker, C.M., D’Hooghe, T.M., Dunsel-\nman, G.A.J., et al. (2017) Research Priorities for Endometriosis: Recommendations \nfrom a Global Consortium of Investigators in Endometriosis. 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(2022) \nESHRE Guideline: Endometriosis. Human Reproduction Open, 2022, hoac009.  \nhttps://doi.org/10.1093/hropen/hoac009","source_license":"CC0","license_restricted":false}