Surgery for Pain Symptoms in Women With Isolated Superficial Peritoneal Endometriosis

STUDY OBJECTIVE: To evaluate the change in overall pain after surgery in participants with suspected isolated superficial peritoneal endometriosis (iSPE), and to identify improvement predictors. DESIGN: Retrospective cohort study. SETTING: Tertiary endometriosis referral center. PARTICIPANTS: Women aged 18 to 45 years with endometriosis-associated pain symptoms and negative preoperative imaging for deep infiltrating or ovarian endometriosis who underwent excisional surgery for suspected iSPE between 2019 and 2024. INTERVENTIONS: Participants were classified into the endometriosis and no endometriosis groups based on surgical findings. Pain outcomes were assessed at short-term (6-12 weeks), medium-term (12 weeks-12 months), and long-term (>12 months) follow-up, using medical records and a structured postoperative questionnaire. MEASUREMENTS AND MAIN RESULTS: A total of 250 participants were included; 158 (63.2%) with surgically confirmed iSPE and 92 (36.8%) with no evidence of disease. Baseline characteristics and preoperative symptoms were similar between groups. Participants with iSPE reported significantly greater pain improvement rates at all follow-up intervals (77.7% vs 56.9% at 6-12 weeks; 80.9% vs 54.1% at 12 weeks-12 months; 82.6% vs 52.9% at >12 months; all p <.01). Endometriosis was the strongest independent predictor of postoperative pain improvement at all follow-up intervals (6-12 weeks: OR = 2.6; 95% CI, 1.4-4.7; 12 weeks-12 months: OR = 3.3; 95% CI, 1.0-10.2; >12 months: OR = 4.4; 95% CI, 2.1-9.2). Long-term improvement was more likely with postoperative hormonal therapy and less likely in participants with adenomyosis. Improvement was greatest for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and gastrointestinal symptoms. CONCLUSION: In our cohort, laparoscopic surgery was associated with significantly greater pain improvement rates in participants with iSPE compared with those without endometriosis. Pain relief in some participants without detectable disease highlights the multifactorial nature of pelvic pain. Prospective studies are needed to confirm these findings and optimize patient selection and treatment strategies.