Surgical resection of endometriosis after prior hysterectomy

Twenty-seven patients who underwent laparotomy after a prior hysterectomy for endometriosis were studied. The mean interval from index surgery to repeat surgery was 7.8 years. Abdominal/pelvic pain was the most common presenting complaint, followed by the objective finding of a pelvic mass. Six patients were taking estrogen replacement therapy. Physical findings suggested a pelvic mass or nodularity in 15 patients. Extensive pelvic adhesions with dense involvement of the ovaries was common. Surgery in 2 patients was complicated by an enterotomy, with 4 patients requiring a bowel resection and anastomosis. Postoperatively, 5 patients developed fever, 3 a postoperative ileus, 1 a wound breakdown, and 1 a small bowel obstruction. The mean hospital stay was 5 days. We conclude that in patients who have undergone a hysterectomy as treatment for endometriosis, subsequent surgery to remove the ovaries involved with recurrent endometriosis carries considerable morbidity. In light of readily available estrogen replacement therapy, conservation of the ovaries in patients who are undergoing a hysterectomy for endometriosis should be applied with caution.