Comparative outcomes of abdominal wall endometriosis surgery: Specialized endometriosis surgeons versus general surgical teams

OBJECTIVE: To assess the preoperative diagnostic accuracy of abdominal wall endometriosis (AWE) by general surgical teams and specialized endometriosis centers in assessing abdominal wall masses using clinical evaluation and imaging. METHODS: A retrospective cohort study included patients with a pathologic diagnosis of AWE who underwent surgical excision between 2007 and 2022. Patients treated by specialized endometriosis surgeons were compared with those treated by general surgery teams. Data collected included patient demographics, lesion size, preoperative symptoms, diagnostic modalities, and surgical outcomes. Statistical analysis was conducted using univariant and multivariable regression models to identify factors associated with misdiagnosis. Correlation between the size of lesion and the need for the use of mesh was also done. RESULTS: A total of 46 patients with AWE were included; 27 (58.7%) were treated by the specialized endometriosis center and 19 (41.3%) by general surgeons. Evaluation by a specialized endometriosis center demonstrated a significantly higher correct diagnosis rate compared to the general surgery group (96.3% vs 42.1%, P < 0.001), with no significant difference in complication rates. Regression model revealed that admission by general surgeons increased the likelihood of misdiagnosis by 28 times (28.01 95% confidence interval [CI]: 2.74-286.47, P = 0.005). Computed tomography (CT) and magnetic resonance imaging were used more frequently in the general surgery group 42.1% versus 3.7%, P = 0.001. Endometriosis ultrasound was used more frequently in the specialized endometriosis group (100% vs 0%, P < 0.001). Independent of the group the probability of mesh use increased markedly for lesions larger than 3 cm with near certainty for lesions larger than 5 cm. CONCLUSION: Evaluation by specialized endometriosis surgeons was associated with significantly higher diagnostic accuracy of AWE detection compared with evaluation by general surgical teams. Early referral to experienced endometriosis units may reduce misdiagnosis and improve surgical planning.