From the Research
Recurrence rates for incisional endometriosis after surgical excision are reported to be around 5-15% within the first few years following treatment, with a study suggesting a recurrence rate of 21.8% in patients with moderate and severe endometriosis 1. The most effective approach to minimize recurrence is complete wide excision of the endometriotic lesion with clear margins.
- Patients should be monitored for at least 2-3 years post-surgery as most recurrences happen during this timeframe.
- Risk factors that increase the likelihood of recurrence include incomplete excision, larger lesions (>3 cm), and a history of pelvic endometriosis.
- Hormonal suppression therapy following surgery, such as continuous combined oral contraceptives, progestins like norethindrone acetate (5-10 mg daily) or dienogest (2 mg daily), or GnRH agonists for 3-6 months postoperatively, may help reduce recurrence rates in high-risk cases, as supported by a systematic review and meta-analysis 2. The recurrence mechanism involves either incomplete removal of microscopic endometrial tissue during the initial surgery or new seeding of endometrial cells during subsequent procedures.
- Patients should be counseled about watching for symptoms like cyclical pain or swelling at the surgical site, which may indicate recurrence requiring prompt evaluation. A study on recurrence patterns after surgery in patients with different endometriosis subtypes found that the time to recurrence is independent from the lesion subtype at first surgery, and that increasing lesion subtype severity occurs in a substantial proportion of patients 3. Another study highlighted the importance of considering scar endometriosis in the surgical practice of incisional site masses of the abdominal wall, and that total excision is necessary for proper treatment, with a reported recurrence rate of 5.9% in their patient population 4.