Laparoscopic versus Laparotomic Surgery for Endometriosis: Fertility and Recurrence in a Retrospective Cohort

Endometriosis is frequently associated with infertility and postoperative recurrence, and fertility-sparing surgery may be considered when symptoms, endometriomas, adhesions, or deep infiltrating disease are unlikely to be adequately managed with medical therapy or assisted reproduction alone. Because the choice of laparoscopic surgery (LS) or laparotomic surgery (LT) is strongly influenced by lesion phenotype and disease burden, pooled surgical comparisons are vulnerable to confounding. This retrospective cohort study evaluated 219 surgically treated patients with pathologically confirmed endometriosis who underwent LS (n = 150) or LT (n = 69) between January 2020 and December 2024. Outcomes were assessed within a 12-month postoperative window. Because comprehensive patient-level subtype-specific analyses were not performed, findings should be interpreted cautiously across heterogeneous endometriosis phenotypes, and any phenotype-specific observations are exploratory. LS was associated with faster perioperative recovery and a higher unadjusted spontaneous clinical pregnancy rate (37.3% versus 23.2%; 42.4% versus 27.1% among patients attempting conception). However, the adjusted odds ratio for any clinical pregnancy within 12 months was not statistically significant (OR = 1.42, 95% CI, 0.80–2.53). Composite recurrence was numerically lower after LS (18.0% versus 29.0%), but the adjusted estimate did not reach statistical significance (HR = 0.63, 95% CI, 0.39–1.03; P = 0.061). These findings support cautious, individualized interpretation in surgically selected patients and should not be interpreted as evidence that LS is superior across all endometriosis phenotypes or all patients with infertility.