Safety and efficacy of retromuscular-onlay dual-mesh reconstruction for massive abdominal wall defects secondary to abdominal wall endometriosis resection

Massive abdominal wall defects resulting from radical abdominal wall endometriosis (AWE) resection present a major reconstructive challenge. This study aims to assess feasibility and short-term safety of a standardized retromuscular-onlay dual-mesh repair technique in this setting. In this single-center retrospective study, 9 patients with massive abdominal wall endometriosis underwent radical excision and standardized retromuscular-onlay dual-mesh reconstruction between January 2024 and June 2025. A series of postoperative complications was analyzed, including surgical site infection, symptomatic seroma, hematoma, wound pain and numbness, mesh infection, incisional hernia, and recurrence of abdominal wall endometriosis. All nine patients, with a history of cesarean delivery, were diagnosed with type III AWE. Clinical presentation uniformly featured a palpable abdominal wall mass and pain accompanying the menstrual cycle. Previous surgical intervention for AWE had been undertaken in 22.2% (2/9) of patients. All reconstructive procedures were successfully performed. We recorded a mean specimen diameter of 9.61 ± 2.56 cm, an operative time of 114.00 ± 41.81 min, and an estimated blood loss of 15.70 ± 11.61 mL. The mean postoperative hospital stay was 8.50 ± 2.72 days, and drains were maintained for a mean of 5.00 ± 1.05 days. In this small cohort study, no surgical site infections, mesh infections, hematomas, or symptomatic seromas requiring intervention occurred. At a mean follow-up of 6 months, no clinical recurrence of AWE or incisional hernia was observed. Only one patient (11.1%) reported a slight numbness in the skin of the surgical area. This standardized dual-mesh reconstruction technique appears feasibility and short-term safety for massive AWE-related abdominal wall defects, with encouraging short-term outcomes and low early complication rates in this initial experience. Longer-term follow-up and prospective multi-center studies are needed to confirm durability.