Endometriosis and Hysterectomy: Does Surgery Type Make a Difference?

How often do patients develop endometriosis following laparoscopic supracervical hysterectomy with uterine morcellation? To better understand the resulting rates of endometriosis via laparoscopic versus transvaginal or abdominal hysterectomies, researchers conducted a single center case-control study. Their findings, which were originally presented at the Society of Gynecologic Surgeons’ 37th Annual Meeting, can be found in the March issue of The Journal of Minimally Invasive Gynecology.

In this case-control study, Dr. Mitchell W. Schuster, surgeon with OB-GYN Associates in Decatur, Alabama, and colleagues compared women who had received laparoscopic supracervical hysterectomies with morcellation (cases; N=277) with women who had transvaginal or abdominal hysterectomies without morcellation (controls; N=187). The procedures were performed from January 2006 through December 2008. In the study, operative procedures for other benign indications were repeated in 3.5% of the patients who had prior hysterectomy.

Schuster et al. found 102 patients with endometriosis at the time of hysterectomy; diagnosis was made via pathologic evaluation or gross visualization. Repeat operative procedures were performed for pain and bleeding in 3.3% of the women without endometriosis. While Schuster and colleagues found newly diagnosed endometriosis in 63% of patients who underwent laparoscopic supracervical surgery, they found that only 28.6% of patients who received transvaginal or abdominal surgery received such a diagnosis. Based on these data, however, the researchers noted the same rate across the groups; both case and control groups had a rate of 1.4% of newly diagnosed endometriosis.

Furthermore, Schuster and colleagues found that repeat operative procedures for pain or bleeding were performed in 2.9% of the patients. All of these patients were from the case group (i.e., received laparoscopic supracervical hysterectomies with morcellation). Schuster et al. noted two out of the three of these women who received a second surgery had recurrent/continued endometriosis.

“Newly diagnosed endometriosis was noted in 1.4% of patients after hysterectomy, with a similar incidence between the LSH [laparoscopic supracervical hysterectomies] and control groups,” the authors concluded. “Reoperation for those with endometriosis at the time of LSH with morcellation was infrequent, but endometriosis was usually found. Further research is needed to delineate risk factors for development of de novo endometriosis after hysterectomy.”

References:

Reference:

MW, Wheeler TL II, Richter HE. Endometriosis after laparoscopic supracervical hysterectomy with uterine morcellation: a case control study. J Minim Invasive Gynecol. 2012;19(2):183-7.