12425 Minimizing Recurrence: A Case of Vaginal Cuff Endometriosis and Discussion on Strategies to Prevent Persistent Disease

To showcase a unique case of vaginal cuff endometriosis and exploration of existing literature to guide discussion on best practices for prevention of recurrent endometriosis after primary surgical resection. Retrospective case study. An urban academic teaching hospital Representative single case study of a primary MIGS patient with stage IV endometriosis previously treated with laparoscopic hysterectomy, who underwent laparoscopic surgical treatment involving the vaginal cuff for continued symptoms. Partial peritonectomy (right side wall), Right ureterolysis. The patient's disease included a complex deeply infiltrating endometriotic lesion involving the right side of the vaginal cuff and a portion of the right ureter. We highlight the patient's disease progression and explore existing literature on prevalence, recurrence and prevention of vaginal cuff endometriosis. We showcase the surgical video of the case including partial peritonectomy and right ureterolysis to remove visible and palpable endometriotic disease. Biopsy results confirmed suspected endometriosis. We showcase a unique case of vaginal cuff endometriosis recurrence after primary surgical treatment with hysterectomy. We synthesize our case and brief literature review to explore how our patient's care could have been optimized. Specifically, we wonder if pelvic MRI at initial presentation may have helped elucidate evidence for deep infiltrating disease, and prompted more thorough disease resection or peritonectomy. We explore the role of ovarian preservation for our patient, as she had recurrence of endometrioma in her preserved right ovary, and later vaginal cuff disease. Most importantly, we highlight the importance of MIGS consult and repeat diagnostic laparoscopy in the setting of chronic pelvic pain consistent with endometriosis, even in patients with prior surgical treatment for endometriosis or comorbidities contributing to chronic pain. Our case demonstrates that significant relief of symptoms can be achieved from effective excision of endometriotic disease.