Few women with endometriosis who undergo hysterectomy need repeat surgery. About 1 in 5 who undergo a major conservative operation with ovarian preservation and 1 in 4 who undergo minor operation need further endometriosis operation. About 1 in 3 individuals who had uterine sparing endometriosis surgery eventually need infertility evaluation. 

A population-based cohort study was carried out to explore the long-term outcomes, including fertility outcomes, symptoms recurrence, and requirement for resurgery of individuals undergoing surgical therapy of endometriosis.

Utilizing the universal coverage health database of females (age 18 to 50 years) undergoing an operation for endometriosis, this study was carried out. The outcomes occurred 30 days after index operation until the end of the trial period or censoring.  To assess the hazard ratios between exposures and outcomes adjusted for confounders, the Cox proportional-hazards regression models were utilized. In total, 84,885 females were enrolled and were followed for a median of 10 years.

In the first postsurgery year, females who underwent diagnostic laparoscopy were considerably more likely to need repeat surgery. On the other hand, those having major conservative surgery were considerably less likely to need repeat surgery. In females who did not experience repeat operation in the first year, those having diagnostic laparoscopy and major conservative surgery without ovarian preservation were less likely to witness repeat operation in comparison to those who had minor operation initially.

In comparison with those initially having a minor operation, participants who witness other therapeutic modalities were less likely to undergo hysterectomy. After minor and major conservative with ovarian preservation operation, about 38.6% and 33.3% of participants sought an infertility consult, respectively. Following five years after index operation, about 29.4% of participants who had a minor conservative operation and 20.7% of major conservative with ovarian preservation operation females had given birth at least once.

Repeat surgery is needed by only a few endometriosis females who undergo hysterectomy. There is a need for further endometriosis operation in 1 in 4 females who go through the minor operation and 1 in 5 females who go through the major conservative operation with ovarian preservation.