Although surgery is considered the treatment of choice for managing symptomatic endometriosis, post-operative symptomatic recurrence of endometriosis has been encountered frequently in gynecology outpatient clinics.  According to the available data, recurrence rate of symptoms after the first conservative surgery is 20 %and 40% in 2 and 5 years respectively while after the second surgery is about 15% to 20% (Human Reproduction Update, Vol.15, No.4 pp. 441–461, 2009).

 Objective: to evaluate the value of repeat conservative surgery for endometriosis.

Method: retrospective analysis of 14 women recruited from the database of Waikato Hospital. All patients had undergone at least 2 laparoscopic excision of endometriosis from 2001 to 2014

Total number of laparoscopic excision of endometriosis in that time period was 398 cases performed by the same surgical team.

55 patients were re refereed to outpatient clinics for persistence or recurrence of symptoms.

14 patients received a second conservative surgery.

 Inclusion criterion:

1- Histological evidence of endometriosis on surgery 1.

2-Patients who had 2 or more procedures performed by the same surgical team.

Results

Retrospective analysis of the 14 patients included

1- Disease severity diagnosed at surgery 1:

 (Stage 3: 21%), (stage 2:  50%), (stage 1: 28 %)

2- Improvement of symptoms after surgery1

(Minimal to No 35%), (Moderate 42%), (Marked 21%)

3- Hormonal treatment after surgery1

No hormonal treatment 35%, Mirena/OCP 64%

4-Pregnancy after surgery1

3 patients (21%)

5-Endometriosis staging at surgery 2

(6 pts Improved 43%), (7 pts stayed the same 50%), (2 pts progressed 15%)

6- Histological confirmation of endometriosis after surgery 2

(10 patients +ve histology 71%), (4 Patients -ve 29%)

Conclusion:

1-    5 of 14 patients reported no improvement of symptoms after surgery 1.  4 of those 5 patients (80%) still reported no improvement after surger2. Two of those 4 patients had negative histology for endometriosis in surgery 2.

2-    9 of 14 patients reported moderate to marked improvement of symptoms after surgery1.  6 of those patients (66%) still reported satisfactory improvement of symptoms after surgery 2 in 3 – 5 years follow up.

3-    9 of 14 patients used hormonal treatment between surgery 1 and 2.

4-    According to this small study, there is a role for a second conservative surgical procedure especially with symptomatic improvement after surgery 1; however a bigger multicenter study is warranted to provide a bigger sample size.