Umbilical endometriosis after unprotected removal of uterine pieces through the umbilicus

We reviewed the frequency of umbilical endometriosis after laparoscopic-ass isted subtotal hysterectomy with unprotected removal of uterine segments th rough the umbilical incision. Retrospective analysis of surgical records wa s followed by recall and clinical examination of 10 patients. Two women dev eloped umbilical endometriosis. One was the only patient operated during me nstruation. The other was one of two women operated in the late luteal phas e and with subsequent adequate exposure to endogenous or exogenous estrogen s. From 1976-1997, 22 reports of umbilical endometriosis were published: 18 cases were spontaneous, 2 occurred after ring sterilization, and 2 after d iagnostic laparoscopy, These data lend support to the concept that implanta tion and the potential development of menstrual endometrium are increased a fter surgery. It is speculated that procedures that expose menstrual endome trial cells to nonepithelialized areas could be associated with an increase d risk of endometriosis.