Abdominal wall endometriosis: pathogenesis, diagnosis, and update on minimally invasive treatment options: a narrative review

Abstract

Background and Objective: Abdominal wall endometriosis (AWE) is a rare presentation of extrapelvic endometriosis, characterized by the presence of endometrial-like tissue on the abdominal wall, often associated with previous abdominal surgeries, such as cesarean sections. This review aims to provide a comprehensive overview of the incidence, pathogenesis, diagnosis, and classic treatment options for AWE. Additionally, it explores the latest evidence on newer minimally invasive techniques, highlighting their potential benefits over traditional methods. Methods: A literature search was conducted using the PubMed database, covering articles published from 2008 to 2024. Both MeSH terms and free-text search strategies were employed to identify relevant studies. Included articles were in English and focused on the clinical presentation, pathogenetic mechanisms, diagnostic methods, and therapeutic options for AWE. Key Content and Findings: The review discusses the pathophysiology of AWE, challenges in diagnosis, and a range of treatment modalities including traditional surgical excision, percutaneous cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound, and sclerotherapy using agents like ethanol and lauromacrogol. Key findings emphasize advancements in less invasive treatments, with emerging evidence suggesting comparable or superior outcomes to classical surgical excision in specific scenarios. Conclusions: Emerging treatments for AWE, such as image-guided ablation techniques, offer viable alternatives that may be better suited for select patients, providing reduced morbidity, fewer complications, and faster recovery compared to traditional surgery. These insights guide future research and hold significant implications for evolving clinical practice in managing AWE.