Endometriosis affects approximately 8 to 15% of women [1]. While most affected women have endometrial implants within the peritoneum, extraperitoneal pelvic locations can also be observed [1], [2], [3], [4]. Abdominal wall endometriosis (AWE) generally develops on or near an abdominal surgical scar, particularly after Cesarean section or hysterectomy, with an incidence of 0.03% to 3.5%, which is probably underestimated [5], [6], [7], [8], [9]. The most common clinical presentation of AWE is a painful abdominal wall mass. The pain is typically cyclical and intensifies during menstruation [5,10,11]. The pathophysiology is not entirely understood but iatrogenic seeding of endometrial cells during intervention is the most recognized cause although spontaneous development of AWE nodules has also been described [5,9,12,13]. The diagnosis of typical AWE can be made using magnetic resonance imaging (MRI) but should be confirmed with biopsy in case of doubt. The two main treatment options currently include hormonal agents such as progestins, which have a low success rate with temporary effectiveness and adverse effects, and surgery, which is not free from morbidity [14]. Surgery is accompanied by localized skin damage, an increased risk of postoperative complications such as eventration and fistula, and a risk of local recurrence estimated between 4% and 11.4% [5,7,10].

Percutaneous ablation techniques, especially cryoablation, have shown their effectiveness in the treatment of soft tissue tumors [15], [16], [17]. Cryoablation is a more tissue-sparing intervention by comparison with surgery and causes less damage to the surrounding tissues [18], [19], [20]. In addition, viewing the ice ball during the intervention allows direct monitoring of the ablation area. Finally, unlike percutaneous radiofrequency ablation, cryoablation is well tolerated by patients under local anesthesia or sedation, with less pain during and after surgery [21]. However, despite its advantages, a limited number of studies have evaluated percutaneous cryoablation in the treatment of AWE. As a consequence, it is necessary to provide further evidence on the efficacy and safety of percutaneous cryoablation in order to promote this minimally invasive technique [9,[22], [23], [24], [25], [26], [27]].

The main purpose of this study was to evaluate the efficacy of percutaneous cryoablation on pain relief in women with AWE nodules. Secondary objectives were the identification of potential complications, feasibility under local anesthesia and imaging changes of AWE nodules treated with cryoablation.