Abstract: Objective: To compare the efficacy, safety, recurrence rates, patient satisfaction, and cost-effectiveness of medical versus surgical management in patients with histopathologically confirmed scar endometriosis.
Methods: This prospective comparative study included 50 patients with scar endometriosis treated at a private practice setting over 36 months. Patients were allocated to either medical management with hormonal therapy (n=25) or surgical management with wide local excision (n=25). Outcomes were assessed at 1, 3, 6, and 12 months, including pain scores, lesion size, recurrence rates, complications, patient satisfaction, and cost analysis.
Results: At 12-month follow-up, complete pain resolution was achieved in 84% of surgical versus 48% of medical patients (p<0.001). The surgical group demonstrated superior lesion resolution (88% vs 16%, p<0.001) and lower recurrence rates (8% vs 32%, p=0.037). Overall treatment success was 88% for surgical versus 52% for medical management (p=0.006). Patient satisfaction was significantly higher in the surgical group (p<0.001). Despite higher initial costs, surgical management demonstrated favorable cost-effectiveness with an incremental cost-effectiveness ratio of $5,800/QALY. Lesion size ?3 cm, non-cyclical pain, and medical management were identified as independent predictors of recurrence.
Conclusion: Surgical management of scar endometriosis provides superior outcomes regarding pain relief, lesion resolution, recurrence rates, and patient satisfaction. Medical management may be suitable for selected patients with small lesions or contraindications to surgery. Treatment should be individualized based on specific patient characteristics and recurrence risk factors.
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