Under-recognition of Endometriosis in General Surgery: A National Review of FOI Data

Background: Endometriosis affects 10% of women of reproductive age, yet diagnostic delay remains common, averaging seven years. Although general surgeons frequently perform pelvic procedures, recognition of endometriosis in this specialty remains limited. This study compares diagnostic practices between general surgery and gynaecology to assess missed opportunities for earlier detection. Methods: Freedom of Information (FOI) requests were submitted to 143 NHS organisations across the United Kingdom, collecting data on diagnostic laparoscopies in women aged 16–35 years between 2013 and 2023. Outcomes included rates of initial and delayed endometriosis diagnoses, laparoscopic volumes, and patient complaints. Comparative analysis was performed by specialty. Results: Of the 143 hospitals contacted, 52 provided data for analysis. Between 2013-2023, there were 1,419,366 admissions for abdominal pain in general surgery and gynaecology; 4,356 endometriosis diagnoses were made per annum. General surgeons diagnosed endometriosis in 255 of 8,305 (3.1%; 95% CI 2.7 - 3.5%) laparoscopies; gynaecologists diagnosed endometriosis in 4825 of 21,456 (22.5%; 95% CI 21.9% - 23.1%) laparoscopies. Delayed diagnoses following inconclusiveprocedures occurred in 8.2% of general surgery cases, versus 15.5% in gynaecology. Complaint rates were similar between general surgery and gynaecology in the four trusts that reported data (p=0.49). Conclusions: General surgeons recorded substantially lower endometriosis diagnosis rates than gynaecologists at diagnostic laparoscopy. While case-mix, coding, and follow-up differences may contribute, the magnitude of this disparity supports improved endometriosis recognition, training, documentation, and cross-specialty diagnostic pathways.