Insights Into the Clinical Features, Diagnosis, Treatment, and Prognosis of Post-Surgical Abdominal Wall Endometriosis: A Retrospective Study

Purpose: This study aimed to categorize abdominal wall endometriosis (AWE) according to lesion depth, analyze its clinical features, treatment, outcomes, and prognosis, and share clinical treatment experience. Patients and methods: A retrospective analysis was performed on 187 AWE patients who underwent surgery at the First Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and April 2024. Patients were classified into three types: type I (skin and subcutaneous fat layer), type II (fascia or muscle layer), and type III (peritoneal layer). Clinical features, perioperative outcomes, and recurrence rates were analyzed. Results: Among the 187 AWE patients, 28 (14.97%) were classified as type I, 104 (55.61%) as type II, and 55 (29.42%) as type III. The main complaint was an abdominal wall mass or/and pain (98.39%, 184/187). Both preoperative imaging and intraoperative exploration revealed a significant trend of increasing lesion diameter across types I, II, and III ( P < 0.01). As the depth of endometriosis invasion increased, the proportion of lesions with a maximum diameter of ≥ 3 cm increased ( P < 0.01). Additionally, there was a significant increase in the frequency of intraoperative mesh placement and drainage placement, as well as longer operative time ( P < 0.01). Lesions were mainly located at corner sites of cesarean section incisions: 85.0% occurred in transverse incisions and 87.76% in longitudinal incisions. The three-year cumulative recurrence rate was 6.2%, with no identified risk factors for recurrence. Conclusion: The presence of an abdominal mass or pain in or around a surgical scar should raise suspicion of AWE. Type III AWE is associated with the most severe clinical manifestations, larger lesion diameter, longer operative time, and a higher incidence of intraoperative mesh and drainage placement. Complete surgical excision is the treatment of choice, and the overall recurrence rate is low. Keywords: abdominal wall endometriosis, extra-pelvic endometriosis, cesarean scar endometriosis