Yeung, P., Mohan, A., & Gavard, J. A. (2024). The Long-term Rate of Repeat Surgery After Optimal Excision Surgery of Endometriosis at a Single Tertiary Referral Center. Acta Scientific Women's Health, 7(1), 3-12. https://doi.org/10.20944/preprints202409.1485.v1
Yeung P, Mohan A, Gavard JA. The Long-term Rate of Repeat Surgery After Optimal Excision Surgery of Endometriosis at a Single Tertiary Referral Center. Acta Scientific Women's Health. 2024;7(1):3-12. doi:10.20944/preprints202409.1485.v1
Yeung, Patrick, et al. "The Long-term Rate of Repeat Surgery After Optimal Excision Surgery of Endometriosis at a Single Tertiary Referral Center." Acta Scientific Women's Health, vol. 7, no. 1, 2024, pp. 3-12.
For EndNote, Zotero or Mendeley:
Open access
No open license is recorded for this paper. Reuse terms are set by the publisher.
Repeat surgery after endometriosis excision was 2.5% in one cohort
620 women with confirmed endometriosis had excision surgery, all by one surgeon. About 2.5 out of 100 women needed repeat surgery. Older studies on ablation found repeat surgery in 40 to 60 out of 100 women within 1 to 2 years.
Study at a glance, prospective cohort study: Repeat surgery after endometriosis excision was 2.5% in one cohort. Source: Yeung P et al., 2024, DOI 10.20944/preprints202409.1485.v1.
Key Findings
Repeat surgery followed in 15 of 620 women (2.5%) with histologically confirmed endometriosis. Among the 570 who received optimal excision, 14 (2.5%) had repeat surgery.
At repeat surgery, endometriosis was found in 12 of the 14 women (85.7%) and not found in 2 (14.3%).
The authors cite historical repeat surgery rates of 40-60% within 1-2 years after ablation, a comparison with earlier reports.
60% of women reported hormonal suppression before excision surgery. Across all 4 stages, no significant association appeared between suppression and the stage found at surgery.
304 of 620 women (49%) responded to follow-up. Median follow-up after optimal excision was 25 months (IQR 13-48).
Interpretation
The authors ran a cohort study of women with confirmed endometriosis at one referral center from 2012 to 2019. One surgeon performed all the surgeries, using optimal excision. Repeat surgery after excision was 2.5%, far below historical ablation rates of 40 to 60%. The authors also examined hormonal suppression before surgery. They found no link between suppression and the stage of disease found at surgery. They read this as evidence that suppression does not prevent disease progression. The authors note recall and response bias as limits of the follow-up survey. The authors call for further controlled studies to verify these findings.
RRM Context
RRM looks for the cause of endometriosis and treats it. Excision cuts out the abnormal tissue. Suppressive medications, like hormonal birth control, act on symptoms and hormones. This study adds surgical results for excision.
Our editorial summary of this paper, not the article's abstract.
Abstract
The primary purpose of this prospective cohort study was to determine if treating endometriosis with optimal excision surgery leads to lower rates of repeat surgery as compared to historical rates of repeat surgery by ablation. A secondary outcome was to examine whether the use of hormonal suppression differed before surgery, depending on the stage of endometriosis found at surgery. Optimal excision was defined as completely excising all areas of abnormal peritoneum, wherever found in the pelvis, having looked systematically with near contact laparoscopy. All surgeries were performed by a single surgeon specializing in optimal excision at a tertiary referral center. The rate of repeat surgery after optimal excision surgery for endometriosis was remarkably low (2.5%, 15/620) as compared to historical rates of repeat surgery by ablation. Additionally, the lack of significant evidence between hormonal suppression use and progression of stage of endometriosis provides implicit evidence that hormonal suppression does not prevent progression of the disease. Further controlled studies are needed to verify these findings.
Endometriosis › Surgical Treatment › Recurrence After Surgery · General Gynecology › Clinical Practice › Practice Patterns · Reproductive Surgery › Laparoscopy › Technique
Patrick Yeung, Ayesha Mohan, Jeffrey Gavard
Pat Yeung, P Yeung, A Mohan, Jeff Gavard, J Gavard
DOI 10.20944/preprints202409.1485.v1 10.20944/preprints202409.1485.v1 Yeung et al. 2024, Yeung 2024
01p7jjy08 
