Laparoscopy-assisted versus open surgery for reconstruction of abdominal wall defects following endometriosis resection: a retrospective cohort study

The optimal surgical approach for reconstructing abdominal wall defects after radical resection of abdominal wall endometriosis (AWE) remains debated. This study aimed to compare the perioperative safety, recovery outcomes, and short-term efficacy of laparoscopy-assisted versus open repair for AWE surgery. In this single-center retrospective cohort study, 32 patients who underwent radical AWE resection and abdominal wall reconstruction between July 2023 and June 2025 were included. Patients were divided into two groups: open surgery (n = 18) and laparoscopy-assisted surgery (n = 14). Operative parameters, postoperative recovery, inflammatory markers, pain scores, and complications were compared between the two groups. The two groups were well balanced in baseline characteristics. The laparoscopy-assisted group had a significantly shorter incision length (6.46 ± 0.89 vs. 10.17 ± 1.60 cm, P < 0.001), fewer drainage tubes (0.79 ± 0.43 vs. 2.56 ± 0.51, P < 0.001), shorter drainage duration (2.79 ± 1.85 vs. 4.78 ± 2.60 days, P = 0.017), and shorter hospital stay (5.86 ± 1.83 vs. 7.61 ± 2.40 days, P = 0.026). Consistently, pain scores on postoperative days 3 and 5 were significantly lower in the laparoscopy-assisted group (P < 0.001). Notably, there was no significant differences in total operative time (P = 0.411), intraoperative blood loss (P = 0.453), postoperative specimen diameter (P = 0.876), time to first flatus (P = 0.320), time to first diet (P = 0.533), time to first ambulation (P = 0.443), and total complications (P = 1.000) between the two groups. No significant intergroup differences were found in incisional numbness or chronic pain at 6 months. Additionally, neither group exhibited abdominal hernia or recurrence of AWE. In conclusion, the laparoscopy-assisted approach offers a minimally invasive alternative that enhances early postoperative recovery—evidenced by shorter incisions, fewer drains, and less pain—while maintaining comparable operative times, safety profiles, and AWE radical treatment to the conventional technique.