The outcomes of repeat surgery for recurrent symptomatic endometriosis

Nicola Berlanda, Paolo Vercellini, Luigi Fedele
Current opinion in obstetrics & gynecology · 2010 · vol. 22(4) , pp. 320–325 · doi:10.1097/gco.0b013e32833bea15 · PMID:20543689 · W2070294288
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

Repeat conservative surgery for recurrent endometriosis yields similar pain relief to primary surgery but significantly reduces pregnancy rates, while hysterectomy offers satisfactory pain relief with a lower risk of further surgery if ovaries are removed.

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This review evaluates the efficacy of second-line surgical interventions for managing recurrent symptomatic endometriosis, focusing on both pain relief and fertility outcomes. The authors note that long-term pain recurrence after repeat conservative surgery ranges from 20 to 40%, while hysterectomy carries a 15% risk of persistent pain and significantly higher reoperation rates if ovaries are preserved. Additionally, conception rates drop substantially to 26% following repetitive surgery compared to 41% after primary procedures, highlighting diminished reproductive success with repeated interventions. This paper is centrally about endometriosis — specifically addressing the clinical management and outcomes associated with recurrent disease requiring secondary surgical treatment.

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Abstract

PURPOSE OF REVIEW: To evaluate the efficacy of second-line surgery in the management of recurrent endometriosis. RECENT FINDINGS: Long-term probability of pain recurrence after repeat conservative surgery for recurrent endometriosis varies between 20 and 40%. The association of presacral neurectomy to the treatment of endometriosis might be effective in reducing midline pain; however, no studies have evaluated this procedure among patients with recurrent disease. The medium-term outcome of hysterectomy for endometriosis-associated pain is quite satisfactory; nevertheless, probability of pain persistence after hysterectomy is 15% and risk of pain worsening 3-5%, with a six times higher risk of further surgery in patients with ovarian preservation as compared to ovarian removal. The conception rate among women undergoing repetitive surgery for recurrent endometriosis associated with infertility is 26%, whereas the overall crude pregnancy rate after a primary procedure is 41%. SUMMARY: Repeat conservative surgery for pelvic pain associated with recurrent endometriosis has the same efficacy and limitations as primary surgery. Conversely, after repeat conservative surgery for infertility, the pregnancy rate is almost half the rate obtained after primary surgery. More data are needed to define the best therapeutic option in women with recurrent endometriosis, in terms of pain relief, pregnancy rate and patient compliance.
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The outcomes of repeat surgery for recurrent symptomatic endometriosis - Nicola Berlanda - Paolo Vercellini - Luigi Fedele Purpose of review To evaluate the efficacy of second-line surgery in the management of recurrent endometriosis. Recent findings Long-term probability of pain recurrence after repeat conservative surgery for recurrent endometriosis varies between 20 and 40%. The association of presacral neurectomy to the treatment of endometriosis might be effective in reducing midline pain; however, no studies have evaluated this procedure among patients with recurrent disease. The medium-term outcome of hysterectomy for endometriosis-associated pain is quite satisfactory; nevertheless, probability of pain persistence after hysterectomy is 15% and risk of pain worsening 3–5%, with a six times higher risk of further surgery in patients with ovarian preservation as compared to ovarian removal. The conception rate among women undergoing repetitive surgery for recurrent endometriosis associated with infertility is 26%, whereas the overall crude pregnancy rate after a primary procedure is 41%. Summary Repeat conservative surgery for pelvic pain associated with recurrent endometriosis has the same efficacy and limitations as primary surgery. Conversely, after repeat conservative surgery for infertility, the pregnancy rate is almost half the rate obtained after primary surgery. More data are needed to define the best therapeutic option in women with recurrent endometriosis, in terms of pain relief, pregnancy rate and patient compliance.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Infertility, Female Endometriosis Endometriosis Female Gynecologic Surgical Procedures Humans Infertility, Female Infertility, Female Laparoscopy Laparoscopy Recurrence Reoperation Treatment Outcome

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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