Ablation compared with excision in the surgical management of peritoneal endometriosis: a retrospective study of pain, re-operation, and pregnancy outcomes

OBJECTIVE: The study aimed to evaluate the long-term outcomes of surgical management in patients with peritoneal endometriosis, focusing on postoperative pain trajectories, re-operation rates, fertility outcomes, and the potential influence of hormone therapy. METHODS: This retrospective study included 67 patients with histologically confirmed peritoneal endometriosis who underwent laparoscopic surgery. Surgical management consisted of excision in 62.7% of cases, ablation using bipolar coagulation in 13.4%, and a combination of both techniques in 23.9%. Pain symptoms (dysmenorrhea, dyspareunia, and chronic pelvic pain) were assessed preoperatively at 6 and 12 months, and at a median follow-up of 42 months. Associations between surgical technique, postoperative hormone therapy, and pain outcomes over time were analyzed using mixed linear models. RESULTS: Both excision and ablation were associated with significant and sustained reductions in pain symptoms over time. Dysmenorrhea showed improvement postoperatively, with additional benefit observed in patients receiving hormonal therapy. The type of surgery had no significant effect on dysmenorrhea. Dyspareunia and chronic pelvic pain also improved during follow-up, independent of surgical technique or hormone use. Re-operation was required in 17.9% of cases, with no difference between excision and ablation. Among the 27 patients who wished to conceive, 62.9% achieved pregnancy postoperatively, irrespective of surgical approach. CONCLUSIONS: Both excision and ablation using bipolar coagulation are effective surgical options for peritoneal endometriosis, leading to long-term pain relief and favorable fertility outcomes. Postoperative hormone therapy appears to enhance pain control, particularly for dysmenorrhea. Overall, symptom improvement was more strongly associated with time since surgery than with the specific surgical technique, supporting individualized and multimodal treatment strategies.