Reoperation after initial treatment of endometriosis with conservative surgery

One hundred and fifty-three patients with pelvic endometriosis met the study criteria of infertility, tissue diagnosis, treatment with conservative surgery, and adequate follow-up. The extent of disease was classified according to Acosta and associates.⁶ Pregnancy rates were 10 to 100 per cent in various subclassifications of patients; these pregnancy rates were related to the extent of disease and the existence of concurrent infertility factors. One hundred and seventeen patients were followed up for three years. Reoperation in this group was carried out in 28 patients for recurrent pain and/or persistent infertility. Each patient had diagnostic laparoscopy preceding relaparotomy. The reoperation rate was 40.6 per cent in those patients who remained infertile, whereas this rate was only 3.7 per cent in those patients who conceived following initial operation. The incidence of conception after a second conservative procedure was 12 per cent. However, an equal number of patients in this group required total abdominal hysterectomy as a third procedure for control of recurrent pain. Thus, repeat conservative surgery should play a secondary role in the treatment of patients with infertility and recurrent endometriosis.