A case of persistent endometriosis after total hysterectomy with both salpingo-oophorectomy managed by radiation therapy

Persistent endometriosis after total hysterectomy and both salpingo-oophorectomy (TH with BSO) is a rare condition and the etiology is uncertain. The exact incidence of persistent endometriosis after definitive surgery is not known. In addition, the treatment of persistent endometriosis after complete surgical excision is controversial. We report a case of persistent endometriosis with vaginal and sigmoid-colonic invasion after TH with BSO. The lesions were not responsive to hormonal therapy. The patient was managed successfully by therapeutic pelvic radiation. Received: 26 October 2000 / Accepted: 12 December 2000     

Laparoscopic oophorectomy either with or without hysterectomy for early breast cancer

OBJECTIVES: The aim of this study was to assess the surgical results, complications and pathological findings of laparoscopic ovarian ablation either with or without hysterectomy in women with early-stage breast cancer (BC). METHODS: Ninety women in early breast cancer stage who underwent laparoscopic bilateral salpingo-oophorectomy (BSO) either with or without hysterectomy were identified in a retrospective study conducted between January 2000 and December 2006. Tamoxifen antiestrogen therapy was used prior to hysterectomy. RESULTS: Forty-eight consecutive patients underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and 42 with ovarian ablation only. The mean operative time for the laparoscopic hysterectomy and bilateral salpingo-oophorectomy or BSO alone was 82 min and 47.8 min, respectively. Blood loss was minimal in both groups (range: 20-250 ml). The rate of postoperative complications was very low (4.4%). One of all ovaries removed by laparoscopy showed ovarian breast carcinoma metastasis. Histopathologic examination revealed concomitant findings of leiomyoma, adenomyosis or endometrial abnormalities in 64.5% of hysterectomy specimens. CONCLUSION: Our experience with ovarian ablation either with or without hysterectomy confirmed that the use of a minimally invasive technique is feasible. We assume that ovarian ablation and hysterectomy is an appropriate treatment for premenopausal women at risk (BRCA positive) or for patients with concomitant benign uterine pathology, treated with tamoxifen in first-line therapy. Removing the uterus allows women to take only estrogens rather than combination HRT. Further investigation into the indications of disease where laparoscopic ablative surgery is appropriate in the management of early breast cancer is needed.     

Hystérectomie pour endométriose : avec ou sans ovariectomie

The fate of the ovaries in hysterectomies performed for endometriosis remains controversial. Recent developments in laparoscopic surgery permit excision of the remaining ovary should there be a recurrence of the disorder, leading many to believe that an increasingly conservative approach should be taken.Objectives: to determine the proportion of oophorectomies performed in Quebec for endometriosis, the recurrence risk following hysterectomy, and conservative surgery of the ovaries based on current literature and the opinion of Quebec gynaecologists regarding this issue.Methods: the MED-ÉCHO computerized medical records of Quebec’s Ministère de la Santé were consulted between 1987 and 1991 for data on patients admitted with a diagnosis of endometriosis who underwent hysterectomy, with or without bilateral oophorectomy (10,102 patients). The literature on the recurrence risk of endometriosis following conservative surgery was reviewed. A questionnaire was sent to members of the Association of Obstetricians and Gynaecologists of Quebec in order to determine their opinion regarding surgery for endometriosis.Results: the proportion of hysterectomies with bilateral oophorectomies in women hospitalized for endometriosis in Quebec was 20.9 percent for women below the age of 35, 24.9 percent for those aged 35 to 39, 33.2 percent for those aged 40 to 44, and 55.9 percent for women aged 45 to 49. Current literature estimates the recurrence risk of endometriosis following hysterectomy and conservative surgery of the ovaries at 7.2 percent. Almost 80 percent of Quebec gynaecologists estimated the recurrence risk of endometriosis to be below 25 percent when one healthy ovary was left after removal of all macroscopic lesions.Conclusion: as previously seen in other specialties and for unknown reasons, there is a discrepancy between knowledge and current practice among Quebec gynaecologists concerning this matter. Recent advances in laparoscopic surgery allow us to treat recurrences. The percentage of such recurrences following hysterectomy and conservative surgery of the ovaries is low. It is, therefore, recommended that less bilateral oophorectomies be performed for endometriosis before menopause.     

Laparoscopic surgery in endometriosis

Endometriosis (the presence of endometrial glands and stroma outside of the uterine cavity) is a common gynecologic problem affecting 10% of women in the general population, 40% of women with infertility and 60% of women with chronic pelvic pain. Laparoscopy has revolutionized management of women with endometriosis. Diagnosis of endometriosis depends on visualization of endometriotic lesions and histologic confirmation. Endometriotic implants have a multitude of appearances: powder burns, red, blue-black, yellow, white, clear vesicular and peritoneal windows. Diagnostic laparoscopy is often combined with operative procedures to treat manifestations and symptoms of endometriosis. This often includes removal or laser vaporization of endometriotic implants, lysis of adhesions, restoration of normal anatomy and removal or fulguration of ovarian endometriomas (conservative surgery). Severe incapacitating endometriosis, recurrent endometriosis following conservative surgery and symptomatic endometriosis in women not desiring more children is often treated by laparoscopic unilateral or bilateral salpingo-oophorectomy or laparoscopically-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (radical surgery). Endometriosis affecting the appendix, ureters, bladder wall and rectosigmoid colon could be treated with laparoscopic appendectomy, excision of endometriotic implants or laparoscopic colectomy and anastomosis, respectively. Hydrodis-section and use of CO2 super pulsed laser aid in removal of adherent endomeriotic implants without damage to normal underlying structures. Robotic-assisted laparoscopic surgery promises to provide advantages in the management of women with severe endometriosis secondary to 3-dimensional visualization, decreasing surgeon's fatigue and hand tremors and improving surgical precision.     

Recurrent endometriosis following total hysterectomy with oophorectomy mimicking a malignant neoplastic lesion: a diagnostic and therapeutic challenge

Case report  A woman with a previous hysterectomy and bilateral salpingo-oophorectomy for endometriosis presented with painless vaginal bleeding. Imaging revealed a heterogeneous soft tissue pelvic mass suggestive of a malignant neoplastic lesion. Radical surgery was performed including excision of the pelvic mass and anterior resection of the sigmoid colon. Histopathology revealed endometriosis. Conclusion  The risk of malignant transformation and the difficulty in achieving a preoperative diagnosis make radical surgery inevitable in the management of recurrent endometriosis. The use of hormone replacement therapy after bilateral salpingo-oophorectomy for endometriosis remains controversial and requires careful counseling about recurrence and close follow-up.     

Identifying Preoperative Factors Associated with Nonresponders in Women Undergoing Comprehensive Surgical Treatment for Endometriosis

Study ObjectiveTo examine whether existing quality of health outcome measures can be used to predict or have an association with nonresponse surgery for endometriosis.DesignRetrospective cohort study.SettingsSingle endometriosis referral center.PatientsWomen (n = 198) undergoing surgery for endometriosis.InterventionsValidated health questionnaires and visual analogue scales.Measurements and Main ResultsPatients were given validated health questionnaires, including Endometriosis Health Profile 30, Gastrointestinal Quality of Life Index, EuroQol-5, Hospital Anxiety and Depression Scale, preoperatively and at 12 months after full surgical excision of endometriosis. Visual analogue scales were also used that measured dyschezia, dysmenorrhea, dyspareunia, and chronic pelvic pain. Surgical management was dependent on severity of disease. Superficial disease was treated by laparoscopic peritoneal excision or laser ablation. Deep infiltrating disease involving the bowel was excised completely together with laparoscopic bowel surgery (shave, disc, or segmental resection) with/without concomitant total hysterectomy and bilateral salpingo-oophorectomy. Nonresponders were defined as women who failed to demonstrate an improvement in pain scores 12 months postoperatively. We examined preoperative and postoperative questionnaires, visual analogue scores, and other variables such as age at onset of symptoms, type of surgery, and the presence of postoperative complications comparing responder and nonresponder women to identify the factors associated with nonresponse. Of 102 women treated for superficial endometriosis, 25 (24.51%) were nonresponders. No factors were associated with nonresponse at 12 months. Of 96 women treated for severe endometriosis involving the bowel, 10 (10.41%) were nonresponders. Nonresponders had significantly less preoperative pain (p = .031) and feeling of control (p = .015) than responders. There was no association between nonresponders and women who underwent a hysterectomy with bilateral salpingo-oophorectomy or those with complications. Radical bowel surgery (resection) was associated with nonresponders.ConclusionMinimal preoperative factors are associated with nonresponse for women having surgery for endometriosis. The severity of pain experienced by women with endometriosis may be used to predict their response to surgery.     

A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum

OBJECTIVE: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S): Imaging findings at follow-up evaluation. RESULT(S): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.     

Endometrioid adenocarcinoma arising in endometriosis foci six years after estrogen replacement therapy: a case report

We present a case of a 53-year-old woman who developed an endometrioid adenocarcinoma six years after total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), who was on estrogenic-only hormone replacement therapy (HRT).     

Ovarian remnant syndrome

Ovarian remnant syndrome (ORS) refers to a condition occurring in women who have had a bilateral salpingo-oophorectomy (BSO), with or without a hysterectomy, that leaves behind ovarian tissue. This residual ovarian tissue then results in pelvic pain or a pelvic mass. Risk factors associated with incomplete removal of an ovary and subsequent development of ORS include a history of endometriosis, pelvic inflammatory disease, multiple previous surgeries, and pelvic adhesive disease. Patients most frequently present with chronic pelvic pain, pelvic pain associated with a pelvic mass, or an asymptomatic pelvic mass. Definitive criteria for diagnosis of ORS include a history of BSO with histologic documentation of ovarian tissue obtained during subsequent surgical excision. The recommended treatment for ORS is surgical excision by laparotomy or, more recently, laparoscopy. We present the presentation and management of patients with ORS and a review of the published literature.     

Role of prophylactic hysterectomy in patients at high risk for hereditary cancers

BACKGROUND: Current surgical recommendations for ovarian cancer prophylaxis in women at high risk of developing ovarian cancer include bilateral salpingo-oophorectomy (risk-reducing salpingo-oophorectomy (RRSO)). The role of hysterectomy is unclear. We sought to determine outcomes following prophylactic surgery in high-risk women. METHODS: We surveyed unaffected members of the Gilda Radner Familial Ovarian Cancer Registry who had undergone oophorectomy from 1981 to 2002. Data were collected and analyzed for statistical significance by the Fisher's Exact Test. RESULTS: Two hundred eighty women were surveyed, and 154 (55%) responded; 97% were Caucasian and 14% reported being Jewish. The median age of the respondents was 51 years (range 29-79); median age at oophorectomy was 41 years (range 15-68). Fifty-eight patients (38%) reported a laparoscopic procedure. One hundred five patients (68%) had a simultaneous hysterectomy, and 4 (3%) had a prior hysterectomy. Forty-four patients (29%) underwent BSO only. Of these 44 patients, 40 (91%) did not require a subsequent hysterectomy. Of the 4 who did, 2 were for leiomyomas, one for menorrhagia and the other was unknown. While not statistically significant, of the 3 patients who developed a subsequent gynecologic malignancy, all had undergone a hysterectomy. There was a statistically significant difference in whether or not the uterus was removed as part of the procedure by time period, whereby women treated prior to 1990 had a higher likelihood of having a hysterectomy (P = 0.03). CONCLUSION: The women in our study did not require hysterectomy for prevention of malignancy. We conclude that one should screen for benign gynecological indications for hysterectomy when planning a prophylactic BSO for prevention of ovarian cancer. Other potential risk factors for endometrial cancer, including the role of UPSC in HBOC, remain to be elucidated.     

Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia

STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy. DESIGN: Prospective cohort study (Canadian Task Force classification II-3). SETTING: University-affiliated teaching hospital. PATIENTS: From January 1990 through December 2005, the senior author (GAV) performed primary resectoscopic surgery in 3401 women with AUB. Among these, there were 22 women with atypical (17 complex, 5 simple) endometrial hyperplasia. INTERVENTIONS: All women underwent hysteroscopic evaluation and partial (n = 3) or complete (n = 19) endometrial electrocoagulation and/or resection. Subsequently, 6 women had hysterectomy and bilateral salpingo-oophorectomy (BSO). MEASUREMENTS AND MAIN RESULTS: The median (range) for age, parity, and body mass index were 55 years (24-78 years), 2 (0-4), and 30.1 kg/m2 (22.5-52.2 kg/m2), respectively. Among the 3401 women, there were 22 cases of atypical endometrial hyperplasia, 12 of which were incidentally diagnosed at the time of hysteroscopy (complex 10, simple 2, incidence 0.35%). After hysteroscopic diagnosis or confirmation of diagnosis, 6 women underwent hysterectomy and BSO. Of the remaining 16 women, followed for a median of 5 years (range 1.5-12 years), 1 was lost to follow-up, 1 had only a biopsy to preserve fertility, 1 died from lung cancer after 4 years, and 1 died from colon cancer after 5 years. One patient developed endometrial cancer after 10.5 years with postmenopausal bleeding. She remains alive and well 3.5 years after hysterectomy and BSO. The remaining 11 patients are amenorrheic at a median follow-up of 6 years (range 1.5-12 years). CONCLUSIONS: Resectoscopic surgery in 3391 women with AUB detected 12 incidental cases of atypical endometrial hyperplasia (incidence 0.35%). Skillful resectoscopic surgery may be an alternative to hysterectomy in women with AUB and atypical endometrial hyperplasia, who refuse or are at high-risk for hysterectomy and who are compliant with regular and long-term follow-up.     

Pelvic Pain and Patient Satisfaction After Laparoscopic Supracervical Hysterectomy: Prospective Trial

Study ObjectiveTo evaluate the occurrence and intensity of cyclic pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy and to explore the effect of the procedure on pelvic pain relief in women with perioperative detection of endometriosis and in women with histologic confirmation of adenomyosis.DesignProspective observational study with 12-month follow-up after laparoscopic supracervical hysterectomy (Canadian Task Force classification II-2).SettingUniversity teaching hospital in Norway.PatientsOne hundred thirteen premenopausal women with preoperative cyclic pelvic pain treated via laparoscopic supracervical hysterectomy.InterventionsStudy participants underwent laparoscopic supracervical hysterectomy and were followed up at the outpatient clinic at 12 months after the procedure.Measurements and Main ResultsThe main outcomes were occurrence, intensity, and reduction of cyclic pelvic pain and patient satisfaction measured using an ordinal and a visual analog scale at 12 months after the procedure. Of the 113 women included in the study, 8 were lost to follow-up. Consequently, 105 women (92.9%) were followed up at 12 months after surgery. All women had cyclic pelvic pain preoperatively, but only 34 (32.4%) experienced this pain at 12 months after the procedure. The intensity of pelvic pain was reduced from a mean (SD) of 5.5 (2.4) preoperatively to 0.7 (1.5) at 12 months after the procedure on a visual analog scale of 0 to 10 (p < .01). Endometriosis was diagnosed perioperatively in 14 women (12.4 %), and adenomyosis was confirmed at histologic analysis in 19 (18.1%). In women with perioperative detection of endometriosis or histologic confirmation of adenomyosis, there were no significant differences in main outcomes at 12 months after laparoscopic supracervical hysterectomy when compared with women without these diagnoses.ConclusionLaparoscopic supracervical hysterectomy is associated with high patient satisfaction and reduces cyclic pelvic pain to a minimum by 12 months after the procedure.     

Serum cortisol and acute phase protein concentrations after hysterectomy with and without peritoneal sutures

OBJECTIVE: Although non-closure of the peritoneum still remains a controversial problem, to our knowledge there have been no studies comparing stress response in women who either have or have not had peritoneal sutures. Therefore, we decided to assess cortisol, C-reactive protein and haptoglobin levels in serum obtained following hysterectomy in both sets of patients. MATERIAL AND METHODS: Forty-nine women after total abdominal hysterectomy with bilateral salpingo-oophorectomy were studied, including 28 patients with non-closed peritoneum and 21 women after peritoneal sutures. Cortisol and acute phase protein levels were measured in serum samples obtained before the operation and also 8, 24, 48, 72, 96 and 192 h after surgery. RESULTS: There were no significant differences in the concentration of cortisol and C-reactive protein in blood serum between groups of patients in all time periods. Serum haptoglobin level was not statistically significant between the examined groups in 8, 24, 48, 72, 96 h, but after 192 h it increased significantly in a group of patients who had received peritoneal closure operations. CONCLUSIONS: Our results suggest that closure of parietal and visceral peritoneum does not provide any benefits during the postoperative period.     

Factors associated with climacteric symptoms and the use of hormone replacement therapy

BACKGROUND: To investigate factors associated with climacteric symptoms and the use of hormone replacement therapy (HRT). METHODS: A random sample of women aged 46, 50, 54, 58 and 62 years resident in Goteborg, Sweden (n=5,990) were invited by letter to complete a postal questionnaire concerning the menopause and HRT use. RESULTS: The response rate was 76% (n=4,504). Women with a higher education, who exercised regularly and who had regular spare-time activities felt better and had fewer climacteric complaints (p<0.001) compared to lower educated women, women who exercised infrequently and women who had no spare-time activities. Climacteric symptoms were associated with dryness symptoms (dry eyes, skin, hair and mouth), bilateral salpingo-oophorectomy (SOE), use of psychotropical drugs and use of alternative remedies, previous hysterectomy and full-time occupation. Stepwise multiple regression analysis showed significant correlations between vasomotor symptoms and various dryness symptoms, no menstrual periods and use of alternative remedies. Current HRT-users (13%) had used estrogens for 4.0 years and past users (14%) for 4.3 years. A correlation (p<0.005) was found between HRT use and previous use of contraceptive pills, use of alternative remedies and hysterectomy. Education, occupation and the frequency of exercise did not influence the prevalence of HRT use. CONCLUSIONS: This study has shown that the experience of climacteric symptoms and well-being is associated with many different factors. Women with a higher education and those who exercised regularly were more often symptom-free. HRT use was associated with previous use of contraceptive pills, use of alternative remedies and hysterectomy.     

45岁以上子宫内膜异位症患者的临床特点及分析

目的:探讨45岁以上子宫内膜异位症(内异症)患者的临床特点和治疗。方法:回顾性分析我院手术治疗的288例45岁以上内异症患者的临床资料。结果:288例患者主要临床表现为盆腔包块(76.7%)、痛经(49.3%)、异常阴道流血(29.2%);术中发现合并其他妇科疾病者76.0%,其中妇科恶性肿瘤或癌前病变5.9%;根治性手术60.4%,保留卵巢功能的手术34.7%,保留生育功能的手术4.9%;术后73例(25.3%)行假孕治疗,18例(6.3%)行假绝经治疗;78例(27.1%)行激素替代治疗。随诊超过6个月者175例(60.8%),复发率2.9%(5/175)。结论:45岁以上内异症临床表现不典型,常与其他激素依赖性疾病并存,合并妇科恶性肿瘤及癌前病变的几率较高,建议行根治性手术,术后进行激素替代治疗不增加复发。     

A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes

STUDY OBJECTIVE: To compare operative and postoperative results of laparoscopic supracervical hysterectomy (LSH) and total abdominal hysterectomy (TAH). DESIGN: Cohort retrospective analysis of consecutive patients (Canadian Task Force classification II-3). SETTING: Department of gynecology at a metropolitan medical center. PATIENTS: Two hundred-twenty women who underwent LSH with or without bilateral salpingo-oophorectomy (BSO). Two hundred-twenty women who underwent TAH with or without BSO. Both groups had similar surgical indications and final pathology. MEASUREMENTS AND MAIN RESULTS: Women who underwent LSH had a shorter operating time than those in the TAH group (47.7 +/- 14.6 min vs 74.9 +/- 25.6 min). Hospital stay was significantly shorter in the LSH group, and those patients returned to work sooner. The operative complication rate was higher in the TAH group (2.7% vs 0.9%). Postoperative complication rate for the TAH group was higher than the LSH group (25% vs zero). CONCLUSION: Laparoscopic supracervical hysterectomy is a safe and effective surgical treatment for patients in need of a hysterectomy with or without BSO. The procedure can be performed in an outpatient setting. Patients experience a much quicker recovery than those who undergo TAH, and the complication rate is significantly lower.     

Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle

OBJECTIVE: In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate. DESIGN: Retrospective analysis of operation charts and follow-up data. SETTING: Department of gynecology, in a hospital-based endometriosis treatment center. PATIENT(S): Two hundred twenty premenopausal women. INTERVENTION(S): Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines. MAIN OUTCOME MEASURE(S): During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically. RESULT(S): The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II. CONCLUSION(S): Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.     

Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery

OBJECTIVE: To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy. METHODS: In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who underwent hysterectomy with or without oophorectomy for endometriosis and 120 patients who had laparoscopic excision of their endometriotic lesions only (local excision group) formed the study population. Estimates of reoperation-free survival at 2, 5, and 7 years were calculated using Kaplan-Meier methods, and estimates of risk (hazard ratios) were computed using Cox proportional hazards models. A significance level of .05 was assumed for all tests. RESULTS: In women who underwent local excision with ovarian preservation, the surgery-free percentages were 79.4%, 53.3%, and 44.6%, respectively, at 2, 5, and 7 years. In women who underwent hysterectomy with ovarian preservation, the 2-, 5-, and 7-year reoperation-free percentages were 95.7%, 86.6%, and 77.0%, respectively. In women who underwent hysterectomy without ovarian preservation, the percentages were 96.0%, 91.7%, and 91.7%, respectively. However, in women between 30 and 39 years of age, removal of the ovaries did not significantly improve the surgery-free time. CONCLUSION: Local excision of endometriosis is associated with good short-term outcomes but, on long-term follow-up, has a high reoperation rate. Hysterectomy is associated with a low reoperation rate. Preservation of the ovaries at the time of hysterectomy remains a viable option. LEVEL OF EVIDENCE: II.