Postpartum Gastrointestinal Outcomes in Patients With Endometriosis by Mode of Delivery: A Retrospective Cohort Study

Objective: To evaluate the association between the mode of delivery and gastrointestinal outcomes in patients with endometriosis. Design: Retrospective Cohort Study Setting: TriNetX Research Network encompassing data from 107 healthcare organizations. Population: Patients with endometriosis who underwent either cesarean or vaginal delivery. Methods: Each cohort included 16,652 patients. Propensity score matching was applied to balance age, race, BMI, and tobacco use. Primary outcomes included postoperative adhesions, fistulas, and bowel obstruction. Analyses included risk estimation, Kaplan-Meier survival curves, and recurrence assessments. Main Outcomes Measures: Postoperative adhesions, fistulas, and bowel obstruction. Results: Cesarean delivery was associated with a significantly higher risk of adhesions (9.3% vs. 4.9%; RR 1.89; HR 2.00, 95% CI 1.84–2.18, p < 0.001) and bowel obstruction (1.5% vs. 1.3%; RR 1.21; HR 1.26, 95% CI 1.05–1.51, p = 0.04). No significant difference was observed in fistula formation (0.084% vs. 0.108%, p = 0.48). Survival analysis confirmed a higher cumulative incidence of adhesions and bowel obstruction in the cesarean group. Frequency of repeated events did not differ significantly between cohorts. Conclusion: In patients with endometriosis, cesarean delivery is associated with a higher baseline risk of adhesions and bowel obstruction, especially at first birth, compared with vaginal delivery. These findings highlight the long-term surgical implications of selecting the delivery method in this population and may inform counseling and obstetric decision-making.