Different types of abdominal wall endometriosis have different clinical features and surgical outcomes

OBJECTIVES: To compare the differences in clinical characteristics between different types of abdominal wall endometriosis (AWE) according to the invasive levels of tissue mass. METHODS: 122 patients, who had undergone resection of AWE lesions at our hospital from January 2011 to January 2023, were retrospectively analyzed. The patients were divided into three types according to their deepest level of lesion invasion. Type I designated invasion of skin and subcutaneous tissue; type II, of the fascial rectus abdominis; and type III, of the muscle and/or peritoneum. The general conditions, clinical manifestations, auxiliary examinations, surgical and postoperative conditions, and recurrence, were classified, compared, and analyzed. RESULTS: Of the 122 patients, type I patients accounted for 23.0%, type II patients for 45.1%, and type III for 31.9%. With respect to group comparisons, we observed that as the location of the mass deepened, the size of the mass increased (P < 0.001), the rate of concurrent pelvic endometriosis increased (0%, 7.2%, 10.3%, respectively), the rate of multiple lesions became elevated (3.6%, 10.9%, 15.4%, respectively), the rate of mesh implantation increased (P = 0.0012), and the risk of drainage placement (P = 0.0012) was enhanced, the length of postoperative hospital stay (P = 0.0042) was lengthened, the number of postoperative fever cases (3.6%, 3.6%, 15.4%, respectively) increased. With a median follow-up time of 93 months, only 2 cases, including 1 case in type I and 1 case in type II, were diagnosed as recurrence. Rates were not statistically significant by the different groups. CONCLUSION: The different types of AWE have an impact on surgical results, but no impact on the chance of recurrence. Type III AWE carries more severe clinical manifestations, larger lesion size, longer operative time, higher necessity of mesh implantation, and longer postoperative recovery process. Complete resection of AWE lesion is the main therapeutically approach and shows relatively low long-term recurrency rate.