{"paper_id":"1838c96a-bdbf-4a4d-9d84-d0f1c92d5369","body_text":"Open Journal of Obstetrics and Gynecology, 2026, 16(1), 158-171 \nhttps://www.scirp.org/journal/ojog \nISSN Online: 2160-8806 \nISSN Print: 2160-8792 \n \nDOI: 10.4236/ojog.2026.161019  Jan. 20, 2026 158 Open Journal of Obstetrics and Gynecology \n \n \n \n \nSurgical Management and Postoperative \nQuality of Life in Women with Endometriosis:  \nA Cross-Sectional Study from Two Hospitals in \nYaoundé, Cameroon \nIsidore Tompeen1,2*, Corine Tchuisse Yamendjeu2, Clovis Ourtching3, Kodoume Motolouze1,2, \nJunie Ngaha1,4, Cliford Ebong2,5, Vanina Ngono Akam2,6, Serge Nyada2,6, Loïc Meukem Tatsipie2, \nJulius Dohbit Sama1,2, Esther Meka Ngo Um1,2, Claude Noa Ndoua2,6 \n1Department of Gynecology and Obstetrics, Yaoundé Gyneco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon  \n2Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, \nCameroon  \n3Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, The University of Garoua, Garoua, \nCameroon  \n4Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala, \nCameroon  \n5Department of Gynecology and Obstetrics, Yaoundé Central Hospital, Yaoundé, Cameroon  \n6Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital, Yaoundé, Cameroon  \n \n \n \nAbstract \nBackground : Endometriosis is a chronic inflammatory disease with a substan-\ntial impact on quality of life (QoL) and reproductive health. In sub -Saharan \nAfrica, delayed diagnosis and limited access to specialized care often result in \nadvanced disease at the time of surgery. This study aimed to describe the sur-\ngical characteristics and assess postoperative quality -of-life outcomes among \nwomen operated for endometriosis in two referral hospitals in Yaoundé, Cam-\neroon. Methods: We conducted a retrospective descriptive and analytical study \ninvolving women surgically treated for endometriosis between January 2018 \nand December 2023 at the Yaoundé Gyneco-\nObstetric and Pediatric Hospital. \nMedical records of patients who underwent surgery for endometriosis were \nretrospectively reviewed. Sociodemo graphic, clinical, imaging, surgical, and \npostoperative data were extracted from 50 medical records. Pain intensity was \nassessed using the Visual Analog Scale (VAS), and quality of life was evaluated \nusing the Endometriosis Health Profile -5 (EHP-5) questionnaire before and \nafter surgery. Results:  The mean age was 31.1 ± 5.5 years. The most common \nphenotypes were superficial endometriosis (68%). Advanced disease predom-\nHow to cite this paper: Tompeen, I., Ya-\nmendjeu, C.T., Ourtching, C., Motolouze, \nK., Ngaha, J., Ebong, C., Akam, V.N., \nNyada, S., Tatsipie, L.M., Sama, J.D., Ngo \nUm Meka, E. and Ndoua, C.N. (2026) Sur-\ngical Management and Postoperative Qual-\nity of Life in Women with Endometriosis: \nA Cross-Sectional Study from Two Hospi-\ntals in Yaoundé, Cameroon. Open Journal \nof Obstetrics and Gynecology, 16, 158-171. \nhttps://doi.org/10.4236/ojog.2026.161019 \n \nReceived:  December 28, 2025 \nAccepted: January 17, 2026 \nPublished: January 20, 2026 \n \nCopyright © 2026 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.2026.161019 159 Open Journal of Obstetrics and Gynecology \n \ninated, with a mean endometrioma diameter of 94.1 mm and a 36.4% preva-\nlence of “kissing ovaries.” Deep infiltrating endometriosis (DIE) was identified \nin 38% of cases, including rare diaphragmatic and hepatic involvement. Mod-\nerate to severe disease (rASRM stages III -IV) was present in 70.3% of staged \ncases. Laparoscopy was the primary surgical approac h (88%). A significant \npostoperative reduction in pain was observed, with the mean VAS score de-\ncreasing from 9.5 ± 1.1 to 3.7 ± 2.7 (p < 0.001). The EHP-5 score significantly \nimproved from 698.8 ± 171.0 to 350.6 ± 219.5 (p < 0.001). Surgical complica-\ntions were infrequent (6%). Postoperative conception occurred in 3 of 14 \n(21.4%) patients followed for infertility. \nConclusion:  In our Cameroonian co-\nhort, endometriosis predominantly affects young, nulliparous women, often \npresenting with moderate-to-severe disease. Surgical management, predomi-\nnantly laparoscopic, is associated with significant and meaningful improve-\nments in pelvic pain and quality of life. These findings underscore the critical \nneed for improved diagnostic capabilities and access to advanced laparoscopic \nsurgery in our setting to mitigate the profound personal and societal burden \nof this disease.  \n \nKeywords \nEndometriosis, Surgery, Laparoscopy, Quality of Life, Cameroon  \n \n1. Introduction \nEndometriosis, defined by the presence of endometrial -like tissue outside the \nuterine cavity, is a chronic inflammatory condition affecting an estimated 10% of \nwomen of reproductive age globally [1]. It is a leading cause of chronic pelvic pain, \ndysmenorrhea, dyspareunia, and  infertility, imposing a substantial burden on \nphysical health, mental well -being, socioeconomic productivity, and diminished \nquality of life [2] [3]. \nIn high-income countries, increased awareness and access to advanced imaging \nand laparoscopy have improved early diagnosis and management. For decades, a \npersistent medical myth suggested that endometriosis was rare among women of \nAfrican descent. Recent evidence has decisively debunked this, revealing that Af-\nrican women often suffer from more aggressive, late-stage phenotypes due to sys-\ntemic diagnostic delays [4]. However, endometriosis remains underdiagnosed and \noften misinterpreted as a functional or psychosomatic condition. Cultural nor-\nmalization of menstrual pain, limited specialist availability, and financial barriers \ncontribute to diagnostic delays, resultin g in more extensive disease at the time of \nsurgery [5]. \nThe management of endometriosis is multimodal, encompassing medical ther-\napy, surgery, and often, assisted reproductive technologies. Surgery, particularly \nlaparoscopic excision, plays a pivotal role in providing a definitive diagnosis, re-\nlieving pain, improving fertility in specific cases, and treating associated compli-\ncations [6] [7]. The primary goals of surgical intervention are the complete re-\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 160 Open Journal of Obstetrics and Gynecology \n \nmoval of all visible endometriotic lesions, restoration of normal pelvic anatomy \nthrough adhesiolysis, and symptom alleviation. \nDespite its global prevalence, the clinical profile and surgical outcomes of en-\ndometriosis in Sub-Saharan Africa (SSA) remain poorly characterized. Diagnostic \ndelays are common due to limited access to advanced imaging (e.g., magnetic res-\nonance imaging) and specialized gynecological care, often leading to presentation \nat advanced disease stages [8]  [9]. Furthermore, the availability and outcomes of \nlaparoscopic surgery, the gold standard for endometriosis management, are not \nwell-documented in many African contexts. \nIn Cameroon, as in many SSA countries, there is a critical gap in data regarding \nthe patient -reported outcomes following intervention. Understanding the local \nepidemiological and clinical landscape is essential for developing context -appro-\npriate guidelines and advocating for the necessary resources. \nQuality of life is now recognized as a key outcome measure in endometriosis \nmanagement, alongside traditional surgical and fertility endpoints. Validated in-\nstruments such as the Endometriosis Health Profile (EHP -5) allow standardized \nassessment of patient-centered outcomes [10]. \nThis study aimed to bridge this knowledge gap by describing the surgical as-\npects and evaluating the impact on quality of life and pain in women who under-\nwent surgery for endometriosis in two hospitals in Yaoundé, Cameroon. We \nsought to provide evidence on the feasibility and effectiveness of surgical manage-\nment within our resource-constrained setting. \n2. Methods \n2.1. Study Design and Setting \nThis was a hospital -based, descriptive cross -sectional and analytical study with \nretrospective data collection on clinical/surgical profiles and prospective assess-\nment of postoperative outcomes. The study was conducted at two facilities: the \nYaoundé Gynaeco-Obstetric and Pediatric Hospital (HGOPY), a public tertiary \nreferral center, and the Afrique Futur Deo Gracias Hospital in Emana, a private \ninstitution. Both centers offer specialized gynecological surgical services in Ya-\noundé. \n2.2. Study Population \nBetween July 2018 and July 2023, we included all women aged 18 years and above \nwho underwent surgical intervention (laparoscopy or laparotomy) with a histo-\nlogically or surgically confirmed endometriosis, with a complete operative report, \nand available pre- and postoperative clinical data. Patients with incomplete med-\nical records or those who underwent surgery for other primary indications with \nan incidental finding of endometriosis were excluded. \n2.3. Data Collection \nData were collected in two phases: \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 161 Open Journal of Obstetrics and Gynecology \n \n1) Retrospective Phase: A structured data extraction sheet was used to collect \ninformation from medical records, including sociodemographic characteristics \n(age, parity, occupation, education), clinical history (symptoms, duration, infer-\ntility status), preoperative investigations (ultrasound, CA -125, MRI), intraopera-\ntive findings (phenotypes: superficial, ovarian endometrioma, deep infiltrating \nendometriosis; location; the revised American Society for Reproductive Medicine \n(rASRM) stage), surgical details ( approach, procedures performed), and periop-\nerative complications. \n2) Prospective Phase: Eligible patients were contacted by telephone. After ob-\ntaining informed consent, they were interviewed using two validated tools: the \nVisual Analogue Scale (VAS) to assess current pelvic pain intensity (0 = no pain, \n10 = worst imaginable pain) and the Endometriosis Health Profile -5 (EHP -5) \nquestionnaire to evaluate health -related quality of life. The EHP -5 scores [10]  \nrange from 0 (best health) to 100 (worst health) per domain; a higher score indi-\ncates poorer QoL. Preoperative EHP-5 scores were not available in archived med-\nical records and were therefore assessed retrospectively during the postoperative \ntelephone interview. Patients were asked to recall their preoperative health status \nusing the EHP-5 questionnaire, referring specifically to their condition immedi-\nately prior to surgery. Patients were also asked about postoperative conception.  \n2.4. Operational Definitions \nSuperficial Endometriosis:  Peritoneal implants without significant infiltration. \nOvarian Endometrioma: Ovarian cyst with typical “chocolate” fluid content. \nDeep Infiltrating Endometriosis (DIE): Endometriotic lesions infiltrating the \nretroperitoneal space or the wall of pelvic organs to a depth of ≥5 mm (e.g., utero-\nsacral ligaments, rectovaginal septum). \nrASRM Stage: Disease severity classified according to the revised American So-\nciety for Reproductive Medicine classification [11]. \n2.5. Ethical Considerations \nThe study protocol was approved by the Institutional Ethics Committees of both \nparticipating hospitals. For the retrospective component, a waiver for individual \ninformed consent was granted for the analysis of anonymized archived data. For \nthe prospective telephone interview, verbal informed consent was obtained from \nall participants at the beginning of the call. All data were anonymized and kept \nconfidential. \n2.6. Statistical Analysis \nData were entered and analyzed using IBM SPSS Statistics version 26.0. Descrip-\ntive statistics were computed. Categorical variables were expressed as frequencies \nand percentages (%). Continuous variables were expressed as mean ± standard \ndeviation (SD) or m edian with interquartile range (IQR) as appropriate. The \npaired samples t-test or Wilcoxon signed-rank test was used to compare preoper-\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 162 Open Journal of Obstetrics and Gynecology \n \native and postoperative VAS and EHP-5 scores, as appropriate. A p-value of <0.05 \nwas considered statistically significant. \n3. Results \n3.1. Flow of Participants and Sociodemographic Characteristics \nA total of 92 patients were identified as having undergone surgery for endometri-\nosis. After applying exclusion criteria, 50 patients constituted the final study pop-\nulation (Figure 1 ).  \n \n \nFigure 1.  Flow diagram. \n \nThe mean age at surgery was 31.1 ± 5.5 years, with the 30 -  35 age group being \nmost represented (34%). The majority were single (52%), had a university -level \neducation (74%), and resided in urban areas (84%). A striking 80% were nullipa-\nrous (\nTable 1 ). \n \nTable 1 . Sociodemographic characteristics. \nCharacteristics  N = 50  % \nAge   \nMeans ± SD 31.1 ± 5.5  \nRange 20 - 42  \n[20 - 25[ 6 12 \n[25 - 30[ 13 26 \n[30 - 35[ 17 34 \n[35 - 40[ 9 18 \n[40 - 45] 5 10 \nLevel of education    \nHigher education 37 74 \nSecondary 11 22 \nPrimary 1 2 \nNone 1 2 \n\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 163 Open Journal of Obstetrics and Gynecology \n \nContinued  \nMarital  Status    \nSingle 26 52 \nMarried 24 48 \nParity   \nNulliparous 40 80 \nPrimiparous 4 8 \nPauciparous 2 4 \nMultiparous 2 4 \nResidence    \nUrban 42 84 \nRural 8 16 \n3.2. Clinical Presentation and Phenotypes \nDysmenorrhea was nearly universal (96%), followed by chronic pelvic pain (54%) \nand deep dyspareunia (66%). Infertility was a presenting complaint in 44% of pa-\ntients (primary: 68.2%, secondary: 30.4%). Preoperative workup relied heavily on \npelvic ultrasound (34% had a specific mention), with fewer patients undergoing \nCA-125 testing (18%) or MRI (8%). \nThe most frequent phenotypes encountered were superficial peritoneal endo-\nmetriosis (68%) and ovarian endometriomas (66%). Deep infiltrating endometri-\nosis was present in 38% of cases, most commonly involving the uterosacral liga-\nments (73.7% of DIE cases) and causing partial or complete obliteration of the \npouch of Douglas (38% of all patients and 100% of DIE). Among the 27 patients \nformally staged, moderate (Stage III, 44.4%) and severe (Stage IV, 25.9%) disease \nwere predominant (\nTable 2 ). \n \nTable 2 . Clinical presentation and phenotypes. \nCharacteristics  N = 50  % \nChronic pelvic pain 27 54 \nDysmenorrhea 48 96 \nDeep dyspareunia 33 66 \nInfertility  22 44 \nPrimary 15 68.2 \nSecondary 7 31.8 \nEndometriosis  phenotypes   25 \nSuperficial endometriosis 34 68 \nEndometrioma 33 66 \nDeep endometriosis 19 38 \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 164 Open Journal of Obstetrics and Gynecology \n \nContinued  \nDeep endometriosis  19 38 \nUterosacral ligament 14 73.7 \nRectovaginal septum involment 6 31.6 \nPouch of Douglas 19 100 \nDiaphragm 1 5.3 \nLiver 2 10.5 \nEndometrioma  33 66 \nLeft 15 45.5 \nRight 6 18.2 \nBilateral 12 36.4 \nKissing ovaries 12 36.4 \nrASRM classification  (n = 27)    \nStage I 4 14.8 \nStage II 4 14.8 \nStage III 12 44.4 \nStage IV 7 25.9 \n3.3. Surgical Management \nLaparoscopy was the primary surgical approach in 88% of cases (n = 44). For ovar-\nian endometriomas (n = 33), cyst drainage was systematically done, followed by \ncomplete cyst wall excision (36.4%). Adhesiolysis was performed in 86% of pa-\ntients. Surgical treatment of superficial peritoneal lesions (fulguration or excision) \nwas performed in 34% of cases. For DIE, nodule resection was undertaken in 24% \nof all patients, with shaving of rectal nodules being the most frequent bowel pro-\ncedure (10% of all patients). The intraoperative complication rate was low (6%), \nconsisting of hemorrhages requiring transfusion (\nTable 3 ). \n \nTable 3 . Surgical management. \nCharacteristics  N = 50  % \nRoute of surgery    \nLaparoscopy 44 88 \nLaparotomy 6 12 \nEndometrioma  33 66 \nCyst drainage 33 100 \nComplete cyst wall excision 12 36.4 \nIncomplete cyst wall excision 3 9 \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 165 Open Journal of Obstetrics and Gynecology \n \nContinued  \nSuperficial  endometriosis  17 34 \nFulguration 9 52.9 \nExcision 8 47.1 \nAdhesiolysis 43 86 \nDeep endometriosis  12 24 \nPartial resection of the nodule 7 58.3 \nComplete resection of the nodule 5 41.7 \nShaving of rectal nodule 5 41.7 \nIntraoperative  complication  3 6 \nhemorrhage 3 6 \n3.4. Postoperative Outcomes \nThe mean hospital stay was 3.4 ± 0.9 days. Postoperative medical therapy was pre-\nscribed for only 18% of patients (Triptorelin: 14%, Combined Oral Contracep-\ntives: 4%). \nPain and quality of life outcomes showed dramatic improvement. The mean \npreoperative VAS score of 9.5 ± 1.1 decreased significantly to 3.7 ± 2.7 postoper-\natively (p < 0.001). Among patients providing follow -up data, 75.7% reported a \ndecrease in pain intensity, and 24.3% reported complete resolution (Table 4 ). \n \nTable 4 . Comparison of the VAS score before and after the surgery. \nVariables N = 50 p-value2 \nMaximum  intensity  of preoperative  pain  <0.001 \nMean ± SD 9.5 ± 1.1  \nMedian [IQR] 8.0 [7.8 - 9.0]  \nRange 1.0 - 8.1  \nMaximum  intensity  of postoperative  pain  <0.001 \nMean ± SD 3.7 ± 2.7  \nMédian [IQR] 4.0 [2.0 - 4.0]  \nRange 0.0 - 9.0  \npostoperative  pain evolution    \nDecrease in intensity 28 (75.7%)  \nComplete regression 9 (24.3%)  \nPersistence of pain 13 (35.13%)  \n \nPaired preoperative and postoperative EHP -5 scores were available for 43 pa-\ntients. Seven patients were excluded from paired analysis due to loss to follow -up \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 166 Open Journal of Obstetrics and Gynecology \n \n(n = 7). The mean EHP -5 score improved significantly from 698.8 ± 171.0 pre-\noperatively to 350.6 ± 219.5 postoperatively (p < 0.001). The proportion of women \nwith a “ poor” QoL (EHP-5 score >  550) fell from 86% preoperatively to 18.6% \npostoperatively (Table 5 ). \n \nTable 5 . Comparison of the EHP score before and after the surgery. \nVariables Before, N = 43 After N = 43 p-value \nEHP-5 score   <0.001 \nMean ± SD 698.8 ± 171.0 350.6 ± 219.5  \nMedian [IQR] 750.0 [587.5 - 812.5] 325.0 [231.3 - 587.5]  \nRange 150.0 - 950.0 0.0 - 825.0  \nEHP-5 score categories    <0.001 \n[0, 550] 6 (14.0%) 35 (81.4%)  \n[550, 950] 37 (86.0%) 8 (18.6%)  \n \nAmong the 14 infertile patients available for fertility follow -up, 3 (21.4%) \nachieved spontaneous conception post-surgery. Of these, one pregnancy was on-\ngoing, and two ended in first-trimester miscarriage. \n4. Discussion \nThis study provides a comprehensive snapshot of the surgical management of en-\ndometriosis in a Cameroonian urban setting, highlighting both the significant \nburden of the disease and the tangible benefits of surgical intervention. Our find-\nings contribute to the sparse literature on endometriosis in Central Africa and \noffer insights relevant for clinical practice and health system planning. These find-\nings confirm that women in this setting present at a young age but with advanced \ndisease, consistent with reports from other African data [4] [5]. \nThe demographic profile of our cohort, young (mean age 31 years), predomi-\nnantly nulliparous (80%), and highly educated, aligns with classic descriptions of \nendometriosis patients globally, often characterized by delayed childbearing [12]. \nHowever, the strikingly high rates of nulliparity and nulligestation in our study \nmay reflect a dual reality: the disease ’s impact on fertility and potential sociocul-\ntural factors influencing marriage and pregnancy timing in our context. The over-\nwhelming urban residence (84%) likely indicates disparities in healthcare access, \nwhere rural women with chronic pelvic pain may never receive a definitive diag-\nnosis. \nThe clinical presentation was dominated by severe pain, with near -universal \ndysmenorrhea and high rates of deep dyspareunia and chronic pelvic pain. This \n“pain triad” is a hallmark of endometriosis and its significant impact is quantita-\ntively confirmed by the exceedingly high preoperative VAS (9.5/10) and EHP -5 \nscores [13]. The 44% prevalence of infertility is consistent with global estimates \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 167 Open Journal of Obstetrics and Gynecology \n \nand underscores endometriosis as a major cause of tubal and peritoneal factor \ninfertility [1] [14]. \nThe distribution of disease phenotypes reveals important patterns. While su-\nperficial disease and endometriomas were common, the 38% prevalence of DIE is \nnotable. This is higher than some early laparoscopic series but resonates with \nmore contemporary studies suggesting DIE is frequently underdiagnosed without \nadequate expertise [15] [16]. The high proportion of moderate -to-severe rASRM \nstages (70.3%) points to substantial diagnostic delay, a critical challenge in low -\nresource settings where symptom normalization and limited access to specialized \ncare are prevalent [4] [8]. The reliance on ultrasound over MRI reflects resource \nconstraints, yet pelvic ultrasound, when performed by trained personnel, can ac-\ncurately diagnose endometriomas and suggest DIE [17]. \nThe surgical approach was encouragingly minimally invasive, with 88% of pro-\ncedures initiated laparoscopically. This demonstrates that advanced laparoscopic \nsurgery for complex benign gynecology is feasible in our setting with appropriate \ntraining and infrastructure. The surgical techniques employed, however, reveal a \npragmatic approach. During laparoscopic management of ovarian endometrio-\nmas, cyst drainage and hemostasis were performed using bipolar electrosurgical \nenergy. No ultrasonic or advanced energy devices were routinely available during \nthe study period. The preference for cyst drainage over excision for endometrio-\nmas, while less optimal for preventing recurrence, may be influenced by concerns \nover ovarian reserve and the technical difficulty of complete excision in the pres-\nence of dense adhesions [ 18] [19]. However, this may be a double -edged sword, \nas drainage is associated with higher recu rrence rates and may contribute to the \n35% of patients experiencing persistent pain. The relatively low rate of complete \nresection of deep nodules (41.7% of those resected) highlights the technical com-\nplexity of DIE surgery and  the need for multidisciplinary teams, which may not \nbe routinely available [20]. \nThe core finding of this study is the profound improvement in patient-reported \noutcomes. The statistically and clinically significant reduction in pain (VAS de-\ncrease of 5.8 points) and the dramatic improvement in EHP -5 scores represent a \ntransformative effect of surgery on women’ s lives. These results are comparable \nto or even exceed those reported in high -income settings following laparoscopic \nexcision, affirming the effectiveness of surgical care when it is accessible [21] [22]. \nThe fact that only 18% of patients received postoperative hormonal suppression \n(primarily Triptorelin) suggests that symptom relief was largely attributable to \nsurgery itself. This is an important consideration in contexts where long -term \nmedical therapy may be unaffordable or poorly tolerated. The low utilization of \npostoperative hormonal therapy reflects a combination of factors specific to our \ncontext, including financial constraints, limited access to long -term hormonal \ntreatments, patient preference,  and the absence of standardized local postopera-\ntive protocols. In addition, some providers prioritized surgical symptom relief \nalone, particularly in patients desiring pregnancy, thereby limiting the prescrip-\n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 168 Open Journal of Obstetrics and Gynecology \n \ntion of suppressive hormonal therapyQuality -of-life improvement after surgery, \nunderscores that, even in resource -limited settings, surgical treatment can yield \nmeaningful patient -centered benefits. However, the modest fertility outcomes \nhighlight the need for earlier diagnosis and integrated fertility care. \nThe fertility outcomes, while based on a small subset, are cautiously promising, \nwith a 21.4% spontaneous conception rate. This aligns with studies showing im-\nproved natural conception rates after surgery for mild-to-moderate endometriosis \n[23]. The high rate of first -trimester miscarriage (66.6% of pregnancies) is con-\ncerning and warrants further investigation into potential associated factors like \nuntreated inflammation or autoimmune phenomena linked to endometriosis [24] \n[25]. \nThis study has several strengths, including its focus on patient -centered out-\ncomes using validated tools (VAS, EHP -5), the combined data from public and \nprivate sectors, and the detailed reporting of surgical phenotypes. However, limi-\ntations must be acknowledged. The sample size, though robust for the local con-\ntext, limits subgroup analyses. The cross-sectional design with retrospective clin-\nical data collection is susceptible to information bias. The follow -up period for \nfertility assessment was variable and likely insufficient to capture all potential con-\nceptions. We lacked a control group (e.g., medical management only) and data on \nlong-term recurrence rates. The reliance on telephone interviews for outcome as-\nsessment, while practical, may introduce recall bias. This retrospective assessment \nof baseline EHP-5 scores introduces a potential recall bias, as patients’ recollection \nof preoperative quality of life may be influenced by their postoperative improve-\nment. This limitation should be considered when inte rpreting the magnitude of \nchange in EHP-5 scores. \n5. Conclusion and Recommendations \nThis study demonstrates that endometriosis in Yaoundé presents as a severe, pain-\ninducing condition, often diagnosed at advanced stages and primarily affecting \nyoung nulliparous women. Surgical management, predominantly laparoscopic, is \nstrongly associated with significant improvements in pain and quality of life, rep-\nresenting a vital therapeutic pathway. \nTo build upon these findings, the authors recommend the following actions:  \n- Enhance diagnostic capacity through training in advanced pelvic ultrasound \nand improved access to MRI for suspected deep infiltrating endometriosis \n(DIE) to reduce diagnostic delays. \n- Strengthen surgical training and multidisciplinary care by supporting special-\nized training in laparoscopic deep excisional surgery and fostering collabora-\ntion with colorectal and urological surgeons for complex DIE cases. \n- Develop integrated postoperative care through standardized protocols for hor-\nmonal suppression and structured fertility counseling, bridging surgical and \nreproductive medicine services. \n- Promote patient advocacy and awareness via public and professional education \ncampaigns to destigmatize chronic pelvic pain and encourage early referral. \n\nI. Tompeen et al. \n \n \nDOI: 10.4236/ojog.2026.161019 169 Open Journal of Obstetrics and Gynecology \n \n- Advance prospective research by establishing a national endometriosis registry \nto track long -term surgical outcomes, recurrence rates, and fertility success, \nthereby generating robust local evidence to inform policy and practice. \nEffectively addressing endometriosis in Sub -Saharan Africa requires a con-\ncerted effort to bridge the gap between the significant unmet need and the demon-\nstrated potential of surgical care to restore health and hope. \nAuthors’ Contributions \nAll authors who contributed to this work have declared that they have read and \napproved the final version of the manuscript. \nConflicts of Interest \nThe authors have no conflicts of interest to declare regarding the publication of \nthis manuscript. \nReferences \n[1] Zondervan, K.T., Becker, C.M., Koga, K., Missmer, S.A., Taylor, R.N. and Viganò, P. \n(2018) Endometriosis. 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Human Reproduction Update, \n24, 577-598. https://doi.org/10.1093/humupd/dmy020 \n[25] Miller, J.E., Ahn, S.H., Monsanto, S.P., Khalaj, K., Koti, M. and Tayade, C. (2016) \nImplications of Immune Dysfunction on Endometriosis Associated Infertility. Onco-\ntarget, 8, 7138-7147. https://doi.org/10.18632/oncotarget.12577","source_license":"CC0","license_restricted":false}