Reoperation After Minimally Invasive Endometriosis Surgery: A Phenotype-Specific Meta-analysis of 22,644 Patients

Maria Julia Lemos, Lemos MJ, Ana Clara Pimenta Servidoni, Servidoni ACP, de Mattos ILL, Iaci Luisa Lopes de Mattos, Nakayama CMA, Camila Miki Aihara Nakayama, Julia Molisani, Molisani J, Julia Terra Molisani, YoussefYoussef, Maurício Simões Abrão, Mauricio S Abrao, Abrao MS
Journal of Minimally Invasive Gynecology · 2026 · doi:10.1016/j.jmig.2026.07.018 · PMID:42498214 · W7170496564
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This meta-analysis of 22,644 patients found a 10.81% reoperation rate after minimally invasive endometriosis surgery, which varied by disease subtype, surgical strategy, and postoperative treatment.

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Abstract

OBJECTIVE: To estimate the incidence of reoperation after minimally invasive surgery for endometriosis and to explore differences according to disease subtype, surgical technique, hysterectomy, postoperative hormonal therapy, and follow-up duration. DATA SOURCES: We conducted a systematic review and meta-analysis according to PRISMA and Cochrane guidance. PubMed, Embase, and CENTRAL were searched from inception to May 2026. METHODS OF STUDY SELECTION: Eligible studies enrolled women with surgically confirmed endometriosis treated by minimally invasive surgery and reported reoperation after the index procedure. Pooled event rates were estimated using random-effects generalized linear mixed models. Risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence was evaluated with GRADE. The primary outcome was the reoperation rate after minimally invasive surgery for endometriosis. Subgroup analyses were conducted according to surgical technique and endometriosis subtype. We also evaluated reoperation rates according to postoperative hormonal treatment use after the index surgery and the risk of subsequent hysterectomy following endometriosis surgery. TABULATION, INTEGRATION, AND RESULTS: Fifty-seven studies including 22,644 patients were included. The pooled reoperation rate was 10.81% (95% CI 8.10 to 14.0; I2=95.7%). In subgroup analyses, reoperation rates were lower in colorectal endometriosis (5.14%), and urinary tract endometriosis (3.98%) than in mixed disease and peritoneal disease, although heterogeneity was substantial. Among studies reporting postoperative hormonal management, reoperation was lower in patients receiving postoperative medical treatment than in those without treatment (4.40% vs 11.23%). Hysterectomy showed a nonsignificant trend toward lower subsequent reoperation risk (HR 0.48; 95% CI, 0.22 to 1.08). CONCLUSION: Approximately one in ten patients underwent reoperation after minimally invasive surgery for endometriosis. Reported reoperation rates varied according to disease phenotype, surgical strategy, postoperative suppression, and follow-up duration, underscoring the need for phenotype-specific counseling and standardized reporting of long-term surgical outcomes.

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