# Precision surgery for endometriosis: preventing chronic pelvic pain in patients with higher pre-operative pain scores and in patients of advanced age

## TL;DR

Precision surgery for endometriosis significantly reduces chronic pelvic pain, especially in older patients with high pre-surgery pain scores, but younger patients with moderate pain may need additional treatments.

## Contribution

Identifies pre-operative predictors of therapy resistance and highlights the effectiveness of precision surgery for specific patient groups.

## Key findings

- Higher pre-operative pain scores and advanced age correlate with better long-term pain relief after surgery.
- Chronic pelvic pain is a strong predictor of therapy resistance and reoperation risk.
- Multimodal treatment strategies are needed for younger patients with moderate pre-operative pain.

## Abstract

Symptom relief can be achieved for many patients with endometriosis by tailored individual treatment. However, therapy resistance is observed in some patients. This study surveyed patient-reported long-term outcomes after laparoscopic endometriosis surgery and evaluated potential pre-operative predictors for insufficient symptom control.

This retrospective study included patients with complete surgical endometriosis resection treated between 2013–2016 at the Department of Gynaecology and Reproductive Medicine, Jena University Hospital. Our 2020 survey gathered socio-demographic, reproductive, symptom-related, and subjective general condition data from 122 patients. Overall pain intensity was assessed using a numeric rating scale (NRS) from zero (no pain) to 100 (highest imaginable pain). Clinical records provided additional information.

Median time between surgery and interview was 6 years. Postoperatively, the proportion of patients reporting symptoms was considerably reduced (menstrual pain 32.0% vs. 85.2%, chronic pelvic pain [CPP] 40.2% vs. 67.2%, dyspareunia 34.4% vs. 59.8%, hypermenorrhea 17.2% vs. 49.2%; p < 0.001). The majority of respondents (70%) reported improved subjective general condition. Mean NRS Score significantly decreased from 77.2 to 26.6 (p < 0.001). Among pre-operatively infertile women, 45.2% reported successful pregnancies. However, 20–30% of patients did not respond to therapy in one of the analyzed domains. Multivariate logistic regression identified CPP as a strong predictor for failure in permanent pain reduction (OR 5.544, 95% CI 1.338–22.965, p = 0.018) and risk for reoperation (OR 5.191, 95% CI 1.100-24.501, p = 0.038). Higher pre-operative NRS scores and increasing age were associated with better long-term pain relief.

Patients with higher pre-operative pain scores and patients of advanced age benefit significantly from precision surgery, experiencing sustained symptom relief and improved subjective general condition. However, younger patients with CPP and moderate pre-operative pain intensity showed a higher risk for therapy resistance and require multimodal treatment strategies.

The online version contains supplementary material available at 10.1007/s00404-025-07996-7.