Risk factors for postoperative recurrence of abdominal wall endometriosis: a meta-analysis and a 24-year clinical cohort study

Background Abdominal wall endometriosis (AWE) is a common iatrogenic condition following cesarean delivery, yet robust evidence on factors associated with its recurrence remains limited. This study utilizes an integrated evidence synthesis design, combining a primary single-center institutional cohort with a systematic review and meta-analysis.

The study employed a dual-axis complementary design. A retrospective cohort of 259 consecutive AWE patients from Peking University People's Hospital (2001–2025, with complete follow-up in 202 patients) was analyzed. A systematic meta-analysis of global literature (January 2020 to March 2026, 7 external studies plus the institutional dataset) was performed. Pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models as appropriate. Sensitivity analyses (leave-one-out and model comparison) assessed robustness.

The meta-analysis identified three factors associated with recurrence: short latent period (MD = –12.98 months, 95% CI: –20.71 to –5.24, P < 0.01), subcutaneous (Type I) localization (OR = 1.87, 95% CI: 1.16–3.01, P = 0.01), and multifocal lesions (OR = 2.33, 95% CI: 1.45–3.77, P 0.05). The institutional recurrence rate was 3.47% (7/202). Short latent period was the most consistently associated factor with recurrence across sensitivity analyses. Type I localization and multifocality also showed associations in the pooled analysis, but these findings were sensitive to exclusion of individual studies (significance lost after omitting Zang et al. and Song et al., respectively).

Short latent period was the most consistently associated factor with recurrence. Type I localization and multifocality showed associations in the pooled analysis, but these associations were sensitive to individual study exclusion. Our findings suggest that complete excision with an adequate surgical margin appears favorable, whereas limited excision may be associated with higher recurrence risk. Similar content being viewed by others Abbreviations - AWE: - Abdominal wall endometriosis - BMI: - Body mass index - CD: - Cesarean delivery - CT: - Computed tomography - CI: - Confidence interval - ESGE: - European Society for Gynaecological Endoscopy - ESHRE: - European Society of Human Reproduction and Embryology - GnRHa: - Gonadotropin-releasing hormone agonists - HR: - Hazard ratio - LNG-IUS: - Levonorgestrel-releasing intrauterine system - MD: - Mean differences - MRI: - Magnetic resonance imaging - NOS: - Newcastle-Ottawa Scale - OR: - Odds ratios - SAR: - Society of Abdominal Radiology - WES: - World Endometriosis Society

Not applicable. Funding This work was supported by "the Science and Technology Plan Project (Subject) of Tongzhou District, Beijing" (Grant No. 2127000531) and "Peking University People's Hospital Research And Development Funds(RDL2024-25)." Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Medical Research Ethics Committee of Peking University People's Hospital with the approval number 2026PHB474-001. Informed consent was not applicable, as the study used anonymized retrospective clinical data; the requirement for written informed consent was waived by the Medical Research Ethics Committee of Peking University People's Hospital. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Liao, J., Han, R. & Zhu, H. Risk factors for postoperative recurrence of abdominal wall endometriosis: a meta-analysis and a 24-year clinical cohort study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04902-4 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04902-4