Design: Retrospective cohort study

Setting: Community Health System

Patients or Participants: Patients who underwent surgery for suspected endometriosis who had no known surgical history or imaging evidence of endometriosis within the Main Line Health System (MLHS) between November 2022 and December 2023.

Interventions: Patients underwent a diagnostic laparoscopic surgery by a high-volume fellowship trained gynecologic surgeon.

Measurements and Main Results: We identified 51 patients to be included in the final analysis. These patients had no prior surgical history for endometriosis and had no imaging evidence of endometriosis based on preoperative MRI. Mean age for patients included was 32.7 years, mean body mass index (BMI) was 28.4 Kg/m² and the majority of patients included were white (88.2%). The most common indication for surgery was pelvic pain (76.5%), with common preoperative symptoms including but not limited to dysmenorrhea (96.1%), dysuria/urgency (66.7%), dyschezia (52.9%), diarrhea (49.0%), constipation (51.0%), dyspareunia (80.4%), bloating/distension (86.3%), and nausea/vomiting (37.3%). The majority of these patients (88.2%) had previously been treated with a medical form of suppression for endometriosis. However, only 29.4% of patients were on any form of medical suppression at the time of surgery with the most common form of suppression being combined oral contraceptives (40.0%). All of the surgeries in this study were performed by a single surgeon (JSK) and were performed robotically. Endometriosis was confirmed on the final pathology report for 92.2% of patients. The majority of lesions were atypical in appearance with the most common being ashen white lesions (72.6%), followed by classic powder burn lesions (62.8%), and clear vesicular lesions (49.0%).

Conclusion: We found a significantly higher incidence of endometriosis confirmed in patients undergoing diagnostic laparoscopy for this disease compared to historic standards.