Laparoscopic Endometriosis Phenotypes and Preoperative Non-suspicion of Endometriosis in Women With Superficial Disease: A Retrospective Study in Kinshasa

Background Superficial peritoneal endometriosis (SPE) is difficult to identify before surgery, especially without concomitant ovarian or deep disease. We described laparoscopic phenotypes and examined factors associated with the absence of documented preoperative suspicion of any endometriosis among women subsequently found to have SPE. Methods We retrospectively analyzed gynecologic laparoscopies performed at three Kinshasa sites between January 2019 and June 2026 by one surgeon. Superficial, ovarian, and deep phenotypes were recorded as non-mutually exclusive. The analytical outcome was absence of documented preoperative suspicion of endometriosis of any phenotype among women with laparoscopically identified SPE and classifiable preoperative records. Modified Poisson models with robust variance estimated exploratory adjusted prevalence ratios (aPRs). Results Of 1,743 gynecologic laparoscopies, 216 (12.4%; 95% CI, 10.9%-14.0%) showed endometriosis and 1,527 (87.6%) did not. SPE occurred in 139/216 (64.4%), ovarian disease in 137/216 (63.4%), and deep disease in 68/216 (31.5%); 104/216 (48.1%) had overlapping phenotypes. Among 135 women with SPE whose preoperative records were classifiable, 83 (61.5%; 95% CI, 53.1%-69.3%) lacked documented suspicion of endometriosis; this proportion was 46/56 (82.1%) in isolated SPE. In the clinical model, infertility was associated with higher non-suspicion (aPR 1.59; 95% CI, 1.07-2.35), while deep dyspareunia was associated with lower non-suspicion (aPR 0.65; 95% CI, 0.45-0.94). With additional adjustment for coexisting operative phenotypes, the infertility association weakened (aPR 1.39; 95% CI, 0.95-2.04) and the dyspareunia estimate remained borderline (aPR 0.70; 95% CI, 0.49-1.00). Conclusions SPE and ovarian disease were the most common laparoscopic phenotypes in this selected surgical cohort. An absence of documented suspicion of any endometriosis was frequent among women with SPE, especially isolated SPE. Associations with infertility and deep dyspareunia are exploratory and may reflect clinical documentation, surgical referral pathways, and coexisting disease. Prospective standardized assessments are needed.