Ultrasound-guided microwave ablation for the treatment of abdominal wall scar endometriosis

Background/aim: To evaluate the efficacy of ultrasound (US)-guided microwave ablation (MWA) in treating abdominal wall endometriosis (AWE) lesions located at the cesarean scar and to assess the early clinical outcomes of this minimally invasive procedure. Materials and methods: A total of 18 patients diagnosed with AWE based on characteristic clinical and US findings were included in this retrospective study. Preprocedural visual analog scale (VAS) scores, ultrasonographic features, and lesion volumes were recorded. The procedure was performed under both general and local anesthesia to ensure patient comfort and procedural accuracy. Hydrodissection was performed before ablation to minimize the risk of thermal injury. Using US guidance, an MWA antenna was inserted into the AWE lesion, and ablation was performed with the moving-shot technique until the lesion became indistinct as microbubbles formed. Postprocedural VAS scores and lesion volumes were evaluated at 1, 3, and 6 months. Results: After MWA treatment, the median VAS score decreased from 8 (range: 8–10) to 0 (range: 0–1) at 1 month (p < 0.001). The mean volume of AWE lesions was 3.75 ± 2.42 cm3 before the procedure, 3.33 ± 2.1 cm3 at 1 month, 1.89 ± 1.18 cm3 at 3 months, and 0.75 ± 0.6 cm3 at 6 months, showing a significant reduction (p < 0.001). The longest axis and lesion volume progressively decreased during follow-up, with the most pronounced reduction observed at 6 months. Additionally, the volumetric reduction rate reached 79.6% at 6 months (p < 0.001). A minor infection occurred at the procedure site in one patient (5.6%) and was successfully treated with antibiotics. Conclusion: US-guided MWA significantly reduced cyclic pain (median VAS 8–10 to 0–1) and lesion volume at 6 months, with only minor complications observed. Larger, multicenter studies with extended follow-up are warranted to confirm the durability of these outcomes.