Effect of Endometriosis on Surgical Outcomes of Total Laparoscopic Hysterectomy for Benign Indications: A Propensity Score-Matched Analysis

INTRODUCTION: The objective of the study was to retrospectively evaluate the impact of endometriosis on perioperative outcomes in patients undergoing total laparoscopic hysterectomy (TLH) for benign diseases. METHODS: Among 836 patients who underwent TLH for benign conditions at our institution between January 2011 and December 2024, patients were divided into two groups: those with endometriosis (n = 115) and those without endometriosis (n = 721). Propensity score matching (PSM) was performed to balance baseline characteristics. After matching, 115 patients were included in each group. Perioperative outcomes were compared, including the incidence of surgical site infection (SSI), bowel injury, urinary tract injury, and deep venous thrombosis (DVT). RESULTS: Before PSM, the endometriosis group had significantly higher rates of superficial and deep incisional SSI (4.3% vs. 1.2%, p = 0.032) and organ/space SSI (15.7% vs. 3.9%, p < 0.001) compared with the non-endometriosis group. The incidence of intraoperative bowel injury was also significantly higher in the endometriosis group (3.5% vs. 0.3%, p = 0.004). In contrast, there were no significant differences between the groups in urinary tract injury (2.6% vs. 1.2%, p = 0.221) or DVT (0.9% vs. 0.1%, p = 0.256). After PSM, the incidence of organ/space SSI remained significantly higher in the endometriosis group (p = 0.032), whereas no significant differences were observed in superficial plus deep incisional SSI, bowel injury, urinary tract injury, or DVT. CONCLUSION: Endometriosis was associated with an increased incidence of organ/space SSI in patients undergoing TLH for benign diseases.