Surgical Treatment of Endometriosis

Shakiba K, K Shakiba, Khashayar Shakiba, Bena JF, James Bena, James F Bena, Kimberly M. McGill, McGill KM, Minger J, Jill Minger, Tommaso Falcone, Falcone T
Obstetrics and gynecology · 2008 · vol. 111(6) , pp. 1285–1292 · doi:10.1097/aog.0b013e3181758ec6 · PMID:18515510 · W2127971155
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-06 ⓘ

Laparoscopic endometriosis excision shows good short-term outcomes but a high reoperation rate, whereas hysterectomy has low reoperation rates, with ovarian preservation being a viable option.

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This retrospective study evaluated the long-term need for subsequent surgery in 240 women treated for endometriosis-associated pain at the Cleveland Clinic. The researchers compared reoperation-free survival rates over seven years between patients who underwent local excision of lesions and those who received hysterectomy, with or without oophorectomy. Results indicated that while local excision had a high reoperation rate by year seven, hysterectomy provided significantly better long-term outcomes, although ovarian preservation remained a viable option for many patients. This paper is centrally about endometriosis — specifically analyzing surgical management strategies and their impact on the requirement for further interventions.

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Abstract

OBJECTIVE: To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy. METHODS: In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who underwent hysterectomy with or without oophorectomy for endometriosis and 120 patients who had laparoscopic excision of their endometriotic lesions only (local excision group) formed the study population. Estimates of reoperation-free survival at 2, 5, and 7 years were calculated using Kaplan-Meier methods, and estimates of risk (hazard ratios) were computed using Cox proportional hazards models. A significance level of .05 was assumed for all tests. RESULTS: In women who underwent local excision with ovarian preservation, the surgery-free percentages were 79.4%, 53.3%, and 44.6%, respectively, at 2, 5, and 7 years. In women who underwent hysterectomy with ovarian preservation, the 2-, 5-, and 7-year reoperation-free percentages were 95.7%, 86.6%, and 77.0%, respectively. In women who underwent hysterectomy without ovarian preservation, the percentages were 96.0%, 91.7%, and 91.7%, respectively. However, in women between 30 and 39 years of age, removal of the ovaries did not significantly improve the surgery-free time. CONCLUSION: Local excision of endometriosis is associated with good short-term outcomes but, on long-term follow-up, has a high reoperation rate. Hysterectomy is associated with a low reoperation rate. Preservation of the ovaries at the time of hysterectomy remains a viable option. LEVEL OF EVIDENCE: II.
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Objective

To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy.

Methods

In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who underwent hysterectomy with or without oophorectomy for endometriosis and 120 patients who had laparoscopic excision of their endometriotic lesions only (local excision group) formed the study population. Estimates of reoperation-free survival at 2, 5, and 7 years were calculated using Kaplan-Meier methods, and estimates of risk (hazard ratios) were computed using Cox proportional hazards models. A significance level of .05 was assumed for all tests.

Results

In women who underwent local excision with ovarian preservation, the surgery-free percentages were 79.4%, 53.3%, and 44.6%, respectively, at 2, 5, and 7 years. In women who underwent hysterectomy with ovarian preservation, the 2-, 5-, and 7-year reoperation-free percentages were 95.7%, 86.6%, and 77.0%, respectively. In women who underwent hysterectomy without ovarian preservation, the percentages were 96.0%, 91.7%, and 91.7%, respectively. However, in women between 30 and 39 years of age, removal of the ovaries did not significantly improve the surgery-free time.

Conclusion

Local excision of endometriosis is associated with good short-term outcomes but, on long-term follow-up, has a high reoperation rate. Hysterectomy is associated with a low reoperation rate. Preservation of the ovaries at the time of hysterectomy remains a viable option. LEVEL OF EVIDENCE: II

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Adult Endometriosis Endometriosis Female Follow-Up Studies Humans Hysterectomy Laparoscopy Ovarian Diseases Ovarian Diseases Ovariectomy Reoperation Retrospective Studies

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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