Laparoscopic Surgery for Endometriosis: A Comparative Analysis of Quality of Life Across Different Healthcare Settings

Objective: To prospectively evaluate quality of life and symptom progression in patients before and after laparoscopic excision of endometriotic lesions, comparing outcomes across type of healthcare service (public vs private) and disease types (superficial vs. deep infiltrating endometriosis). Design: Prospective longitudinal study. Setting: Tertiary care hospitals in Brazil. Patients: A total of 117 reproductive-age women with histologically confirmed endometriosis who underwent laparoscopic surgery for pelvic pain and/or infertility between 2023 and 2025. Patients were categorized into private (n = 41) and public (n = 76) sectors. Intervention: Pain symptoms and quality of life were evaluated preoperatively at 3 and 6 months postoperatively using two validated and culturally adapted tools: the Short Form-36 Health Survey (SF-36) and the Endometriosis Health Profile-30 (EHP-30). Measurements and Main Results: Patients in public healthcare had more advanced disease and greater symptom burden pre-operatively when compared to private sector. Public sector patients presented with more advanced disease and greater symptom burden pre-operatively, however both cohorts achieved substantial postoperative quality of life gains. Nevertheless, SF-36 Physical Functioning (-15.9 ± 4.11; p<0.001) and General Health (-11.67 ± 3.44; p<0.001) improvement was lower in the public sector and the EHP-30 Infertility domain showed a significantly greater reduction in burden for the public sector compared to private (-22.57 ± 7.04; p < 0.001). Both disease types demonstrated comparable patterns of QoL improvement, with gains larger early (up to 3 months) then stabilizing. Conclusion: Laparoscopic surgery significantly improves quality of life for public and private healthcare settings, with also comparable overall improvement regardless of disease depth. While public sector patients present with more advanced disease and higher baseline symptom burden, both public and private settings achieve substantial postoperative gains. These findings underscore the universal benefit of surgery while highlighting the need for comprehensive care pathways to address healthcare disparities and optimize outcomes for all endometriosis patients