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Reoperation After Minimally Invasive Endometriosis Surgery: A Phenotype-Specific Meta-analysis of 22,644 Patients
Maria Julia Lemos1, Ana Clara Pimenta Servidoni2, Iaci Luisa Lopes de Mattos3
1Department of Women's Health, Kurah Women's Health Institute, Macaé, RJ, Brazil.
Journal of Minimally Invasive Gynecology
|July 24, 2026
Summary
Approximately 10.8% of patients require reoperation after minimally invasive surgery for endometriosis. Reoperation rates vary by endometriosis subtype, surgical approach, and use of postoperative hormonal therapy, influencing patient counseling and long-term outcome reporting.
Area of Science:
- Gynecology
- Surgical Oncology
- Epidemiology
Background:
- Endometriosis affects a significant number of women, often requiring surgical intervention.
- Minimally invasive surgery (MIS) is a common approach for endometriosis treatment.
- Understanding reoperation rates after MIS is crucial for long-term patient management.
Purpose of the Study:
- To estimate the incidence of reoperation following minimally invasive surgery for endometriosis.
- To investigate factors influencing reoperation rates, including disease subtype, surgical technique, hysterectomy, hormonal therapy, and follow-up duration.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA and Cochrane guidelines.
- Searches were performed in PubMed, Embase, and CENTRAL databases.
- Random-effects generalized linear mixed models were used to estimate pooled reoperation rates, with risk of bias and certainty of evidence assessed using established tools.
Main Results:
- The pooled reoperation rate after MIS for endometriosis was 10.81% (95% CI 8.10 to 14.0).
- Reoperation rates were lower for colorectal (5.14%) and urinary tract (3.98%) endometriosis compared to mixed or peritoneal disease.
- Postoperative medical treatment was associated with lower reoperation rates (4.40% vs 11.23% without treatment).
Conclusions:
- About one in ten patients undergoing MIS for endometriosis require reoperation.
- Reoperation incidence is influenced by endometriosis phenotype, surgical strategy, and postoperative management.
- Phenotype-specific counseling and standardized reporting of long-term outcomes are essential for improving patient care.
