In recent years, with the increase of cesarean delivery rate, a new type of disease has been gradually derived, which is abdominal wall endometriosis near the surgical scar after cesarean delivery. The incidence of abdominal wall endometriosis after full-term cesarean delivery is 0.03% to 0.4% in Zhang Yu, Department of Gynecology, Peking Union Medical College Hospital. With the increase of cesarean section rate in recent years, the number of patients with abdominal wall endometriosis is also on the rise. Many patients ask me if my cesarean section was not done properly and if it was caused by the doctor, but it is not. I usually explain it in layman’s terms to the patient that a cesarean section actually involves cutting the skin, subcutaneous fat, fascia, and peritoneum layer by layer, then cutting the uterus, removing the baby and placenta, and then suturing them layer by layer. But why only a few people get endometriosis after surgery, while most people have no problem? Basic research suggests that it is mainly related to the biological behavior of the patient’s endometrial cells themselves, probably her endometrial cells have stronger biological activity, stronger invasiveness, stronger transfer As a result, the patient will find abnormal nodules near the surgical incision after surgery, which can be large or small, I have seen large ones as big as a duck egg, and small ones usually the size of a soybean grain. As the period clears, the mass may shrink and the pain may decrease. Typical clinical signs of abdominal wall endometriosis are: (1) history of abdominal surgery, especially cesarean delivery (2) mass at the site of the incision; (3) periodic pain or tenderness of the mass in conjunction with menstruation. For endometriosis of the abdominal wall with atypical symptoms, preoperative differentiation is required from other conditions, including incisional sclerosis, incisional suture granulation tissue, incisional hernia, abscess, hematoma, and abdominal wall tumor. In addition to palpation examination by the surgeon through both hands, ultrasonography is simpler and non-invasive to apply and can measure the size of the lesion, the depth of invasion and infiltration, and the relationship between the lesion and the surrounding tissue structures, and is not expensive. CT and MRI can also be used for preoperative evaluation and are usually used when the lesion is large, or the invasion is deep, or when malignant changes are suspected. Currently, surgical treatment is preferred for abdominal wall endometriosis, with removal of the endometriotic nodule. The extent of surgery is best performed by removing an additional 0.5 cm at the outer edge of the lesion to ensure complete removal of the lesion and reduce the risk of recurrence. For smaller lesions, the surgeon can repair the wound after excision with the most basic surgical reduction sutures, but for patients with huge lesions that invade the fascia and have too many defects after fascial excision, a “big hole” is left in the belly that cannot be sutured, and an artificial fascial patch is needed to sew up the belly like a patch, after surgery. After surgery, the artificial fascia, also known as a biologic patch, will grow and fuse well with the patient’s own tissue to repair the wound. Of all endometriosis patients, abdominal wall type endometriosis lesions are very ineffective for medication, so do not try to get a cure by taking medication, or injections for scar nodule-like lesions that have formed. However, for cases with huge lesions and estimated difficulties in resection, preoperative application of GnRHa drugs (e.g. Noraid, etc.) to treat the lesions to reduce their size and then operate as soon as possible can achieve the purpose of reducing the difficulty of surgery and complications, which is a very good preoperative adjuvant treatment. Abdominal wall endometriosis has a certain recurrence rate, and the literature reports an overall recurrence rate of 10%. In recent years, Concord Hospital has had experience in treating at least 200 cases of abdominal wall endometriosis from all over the country, all of which were treated by surgical excision, with a recurrence rate of no more than 5%. Usually, intravenous anesthesia is sufficient to solve the problem, and the patient can eat and drink and defecate on his own 4 hours after surgery, in short, it is a minor operation. However, if the lesion is huge, the situation is often very complicated, individual patients also need plastic surgeons with obstetricians and gynecologists to carry out plastic suturing of the abdominal wall, individual patients of the abdominal wall lesion will always invade the growth into the abdominal cavity, we have seen the lesion and the uterus connected, when the patient has menstruation, the lesion on the belly will also bleed, is indeed rare and rare cases, the most serious, individual patients will also have lesions In our hospital, we have admitted a patient with sarcoma-like endometriosis of the abdominal wall, who had been surgically removed numerous times in outside hospitals, but kept recurring, and when he came to Concordia, his belly was already miserable. Last year, we also treated a patient with malignant endometriosis of the abdominal wall, who had extensive metastases in the pelvic and abdominal cavities and lymph nodes, which is a rare case all over the world. Therefore, patients with repeated recurrence of the lesion, with the appearance of rupture and decay, need to be highly alert and have a tissue biopsy to confirm the diagnosis if necessary. Author: Dr. Zhang Yu, Associate Professor, Department of Obstetrics and Gynecology, Peking Union Medical College, Beijing, China Sina Weibo: @协和张羽疾病咨询请登录网站： style=”text-align:left;”>”Only the Doctor Knows” series, available at major bookstores Dangdang, Jingdong, Amazon, Taobao.com