Do Interventions on the Uterine Wall Increase the Risk of Developing Abdominal Wall Endometrioma?

Background: Abdominal wall endometriosis, which can affect the rectus abdominis muscle, has been documented in association with cesarean section scars or along pathways formed by abdominopelvic surgeries. Our study aimed to assess the risk of developing abdominal wall endometriomas following surgical interventions (cesarean section, myomectomy) on the uterine wall. Methods: Between 2011 and 2021, a total of 19,574 patients underwent cesarean section delivery through a Pfannenstiel incision. The average age of patients was 36 (20–58) years. On average, 1.5 to 2.0 years after cesarean section, 204 patients developed abdominal wall endometrioma (Group I). The control group (Group II) comprised 204 patients who had undergone cesarean section by the same method but did not develop scar endometriosis. During the same period, 200 patients underwent myomectomy with a similar incision for intramural and submucosal myomas (Group III). Postoperatively, these patients were also monitored for the development of endometrioma. One of the patients who underwent myomectomy also had surgery for an ectopic pregnancy at the same time. The data analysis included descriptive statistical methods, such as calculating the mean ± standard deviation, median (min–max), and frequencies (n (%)). The Shapiro-Wilk normality test, Kruskal-Wallis test, Dunn’s multiple comparison test, Chi-Square test, and Fisher-Freeman-Halton exact test were applied. The results were evaluated for statistical significance at a level of p < 0.05. Results: Abdominal wall endometriomas developed in 204 of 19,574 patients who delivered by cesarean section (1.04%). Endometrioma development was significantly higher in Group I, where estrogen levels were elevated (p < 0.001). The most common complaints among the patients were swelling and cyclical pain in the abdominal wall. 9 of the 204 patients who had previously developed abdominal wall endometriomas experienced recurrence (4.41%). An abdominal wall endometrioma developed in the patient who underwent myomectomy and surgery for ectopic pregnancy simultaneously (0.5%). Conclusions: Endometrioma is a multifactorial condition. High estrogen levels, surgical techniques, and an increased imbalance between estrogen and progesterone levels can trigger inflammation and lead to the development of endometriomas. We suggest that further detailed studies are needed to better understand these mechanisms.