Prevalence of concomitant endometriosis in patients undergoing laparoscopic hysterectomy with suspected adenomyosis: a retrospective cohort study

OBJECTIVE: To determine the prevalence of pathology-proven endometriosis in patients with suspected adenomyosis undergoing total laparoscopic hysterectomy (LH). METHODS: This was a single-site retrospective cohort study performed at an academic medical center. 182 premenopausal patients with suspected adenomyosis underwent laparoscopic hysterectomy between 10/01/2015-10/31/2022 with surgeons with additional specialized training in surgical management of endometriosis. Close peritoneal inspection was performed at time of LH and any visible lesions were excised to capture all cases of endometriosis. Those with and without pathology-proven endometriosis were compared. An additional subanalysis was then performed excluding patients with any pre-operative imaging findings of endometriosis. RESULTS: Concomitant endometriosis was identified in 73.6% of patients with suspected adenomyosis (134/182). Of the patients with pathology-confirmed adenomyosis (93/182), 71.0% had concomitant endometriosis (66/93). Patients with endometriosis were more likely to have severe dysmenorrhea as a presenting symptom (74.6%) compared to patients without endometriosis (58.3%) (p = 0.036). These results remained significant within the subanalysis. CONCLUSION: Endometriosis was found in 73.6% of patients with suspected adenomyosis, which is higher than previously reported. This suggests a role for careful laparoscopic examination of the pelvis at time of hysterectomy in this population in order to account for all pathology. Further confirmation with a larger sample size and pain outcomes would assist with clinical decision-making and counseling.