Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy

The objective of this study was to clarify which is the better surgical conservative treatment for recurrent endometriosis. We compared two consecutive surgical series at a tertiary care centre for the cure of endometriosis. The patients were 81 women with recurrent endometriosis, 41 reoperated at laparotomy from 1986 to 1991 and 40 reoperated at laparoscopy from 1992 to 1996. Follow-up after the second operation included clinical and ultrasound examinations performed at least once a year to evaluate the recovery of fertility and the reappearance of symptoms and signs of the disease. The cumulative probability of recurrence of dysmenorrhoea (34 and 43 respectively), and the frequency of recurrence of pelvic pain and dyspareunia and of clinical findings suggestive of the disease were not significantly different in the two groups. The rate of recurrence of dyspareunia was higher in the patients operated at laparotomy as was the number requiring a third operation. However, this could be due to the longer follow-up of this group. No significant difference was observed between the cumulative pregnancy rates at 24 months in the two groups (45 in the laparotomy and 54 in the laparoscopy group). We conclude that operative laparoscopy seems as efficacious as conservative surgery at laparotomy in the treatment of recurrent endometriosis.