Recurrent endometriosis after laparoscopic surgical treatment: A multi-centre retrospective review.

Abstract

Study Objective: To evaluate the incidence and severity of recurrent endometriosis, success rate of surgery, medical treatment and associated risk factors for recurrence. Design(s):Aretrospective review of patients diagnosed with endometriosis from July 2009 to June 2016. Setting(s):AMulti-centre medical centre with a tertiary level endometriosis unit Patients: Patients who underwent surgery for endometriosis-associated pain, were followed-up in our unit and had complete computerized medical records available. A total of 385 patients were included in the assessment. Intervention(s): N/A Measurements and Main Results: The demographic characteristics, stage of endometriosis, associated medical conditions; type of surgery and other medical treatments were evaluated. Student T-Test and Chi Square Test were used to compare variables. The number of patients diagnosed with stage 1 and 2 endometriosis was 223 (57.9%) and 162(42.1%) stages 3& 4. Pain was an indication for surgery in 330 (85.7%) patients, endometrioma in 136(35.3%) and infertility+/-pain in 63 (16.4%). In patients with preoperative pain, 99 (30%) had complete resolution, 143 (43.3%) had improvement in their symptoms & 71 (21.5%) had no change at the 6-8 week post-operative review. On further follow-up, recurrent pain symptoms were reported in 73 of 242 (30.1%). The average time for symptom recurrence was 14.7 months (range 1-72 months, SD 14.9). Of those patients, 39 (53.4 %) were diagnosed as having stage 1&2 and 34 (46.6%) stages 3&4. All patients were offered post-operative hormonal treatment, 139 (42.1%) chose not to have any. Conclusion(s): Our study confirms the high rate of symptom improvement after laparoscopic excision of endometriosis. However, in accordance with previous studies, the risk of recurrence is high. Our results show no correlation of endometriosis stage and recurrence of pain. Medical treatment did not affect chance of pain recurrence, however, this could be due to the relatively small study population.