(110) Surgical Findings in Adolescents Undergoing Laparoscopy to Evaluate for Endometriosis

Background: Endometriosis is defined as the presence of endometrial glands and stromal lesions outside the uterus, but little is known about endometriosis in the adolescent population. There is debate regarding whether a surgical diagnosis is sufficient or requires histopathologic confirmation. We aimed to review adolescents with pelvic pain who underwent laparoscopic evaluation for endometriosis to describe the association of histopathology with described surgical findings.

Methods: We performed a retrospective chart review of patients at our institution who underwent laparoscopic evaluation for endometriosis by a pediatric gynecologist between 2017 and 2024. Patients were excluded if the primary purpose of surgery did not include evaluation of pelvic pain or endometriosis.

Results: 38 patients (ages 14 to 21 at time of surgery) met inclusion criteria at our tertiary care pediatric hospital. Of these patients, 29 (76%) had surgical findings suggestive of endometriosis, such as vesicular/clear lesions, brown/black lesions, scarring, or evidence of hypervascularity. Of the patients with surgical suspicion for endometriosis, 17 patients underwent excision, 21 had ablation, and 3 had neither. Histopathologic biopsies were taken in 20 patients (1-5 sites biopsied, mean 1.9 sites). 18 patients with suspected endometriosis surgically were biopsied and 13 were positive on histopathology while five were negative. 11 patients who had suspected endometriosis at time of surgery did not have biopsies taken. Two patients had negative laparoscopies who had random biopsies performed; both were negative for histopathologic endometriosis. Seven patients had no endometriosis seen on laparoscopy and no biopsies were performed.

Biopsies were most frequently taken from the posterior cul-de-sac (10) followed by uterosacral ligaments (7). Endometriosis was most frequently Stage I (24 patients) followed by Stage II (4 patients), and one patient with Stage III. Endometriosis was predominantly described as brown/black (21) or as clear or vesicular (16) in color. Ten patients were noted to have adhesions/scarring, and three with additionally noted hypervascularity.

Conclusions: Laparoscopic evaluation and treatment of adolescent endometriosis is an evolving field with limited data. Adolescents in our cohort had multiple types of endometriosis lesions in several areas of the pelvis; some but not all were confirmed to be endometriosis on histopathology. Further research is warranted to clarify whether surgical findings suggestive of endometriosis should be sufficient for diagnosis in adolescents.