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Surgical History and the Risk of Endometriosis:A Hospital-Based Case-Control Study

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Abstract

Women tend to receive more surgical procedures than men. Our mouse study shows that surgical stress promotes the development of endometriosis. This study was undertaken to test the hypothesis that surgery increases the risk of endometriosis. We recruited 208 patients with ovarian endometrioma and 212 age-matched patients with ovarian teratoma and retrieved Information on the history of any surgical procedures after menarche, grouped by laparotomy, laparoscopy, gynecologically related procedures, cesarean section, and surgeries performed on torso and extremities was recorded. We then evaluated the association, if any, between endometriosis and history of surgical procedures. Cases and controls were comparable with respect to age, marital Status, education level, and occupation. Eleven (5.3%) cases had laparotomy before the index surgery while 4 (1.9%) controls did. Sixty-six (31.7%) cases had Cesarean section while 53 (25.0%) controls did. Multivariate analysis identified age, at the index surgery laparotomy, and cesarean section as 3 factors positively associated with the risk of endometriosis while parity was found to be negatively associated with the risk. Laparotomy was associated with increased risk of endometriosis (odds ratio [OR] = 3.64, 95% confidence interval [Cl] = 1.08-12.31), while cesarean section was associated with 2-fold increase in risk (OR = 2.16, 95% Cl = 1.31 -3.55). Both laparotomy and cesarean section may increase the risk of endometriosis probably by activation of adrenergic signaling, thus facilitating angiogenesis and accelerating the growth of endometriotic lesions that are already in exis-tence. This finding may have important ramifications for the perioperative management of patients with increased risk or recurrence risk of endometriosis.

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Authors and Affiliations

  1. Shanghai Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai, 200011, China

    **shi Liu MD, PhD, Qiqi Long MD & Sun-Wei Guo PhD

  2. Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China

    **shi Liu MD, PhD & Sun-Wei Guo PhD

Authors
  1. **shi Liu MD, PhD
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  2. Qiqi Long MD
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Correspondence to Sun-Wei Guo PhD.

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Liu, X., Long, Q. & Guo, SW. Surgical History and the Risk of Endometriosis:A Hospital-Based Case-Control Study. Reprod. Sci. 23, 1217–1224 (2016). https://doi.org/10.1177/1933719116632921

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