Endometriosis is a benign gynaecological condition causing chronic pelvic pain, impaired fertility and dysmenorrhoea. It is difficult to describe the lesion distribution due to the complexity of the disease, inconsistent pattern and sometimes even absent progression.

To describe clinical characteristics and locations of lesions in women with endometriosis using #ENZIAN classification.

This was a retrospective observational cohort study of 154 patients with endometriosis who underwent laparoscopic or robotic endometriosis excision between April 2021 and September 2022 by a single surgeon in a multidisciplinary endometriosis centre. Clinical criteria such as age, demographics, menstrual history, previous endometriosis surgeries, size and location of endometriomas, along with clinical symptoms such as dysmenorrhea, dyschezia, infertility, dyspareunia, urinary frequency and rectal pain were documented. The #ENZIAN [2021] classification was used to assess the distribution of disease.

Mean age of the patients was 32.25 ± 6.107 years, and mean BMI was 23.9 ± 3.36 kg/m2. 47.2% had taken medical treatment for a period of 5.9 ± 11.7 months. Regarding parity, 75.4% were nulliparous, and 40.8% patients had infertility as co-existing complaint. According to #ENZIAN, the left ovarian involvement was observed in 67.4% and bilateral involvement noted in 46.1%. A (rectovaginal vagina and septum) was involved in 61% cases, B (uterosacral ligaments and pelvic wall) 63.58% on left and 60.33% on right and C (rectum and sigmoid colon) 33.1% cases.

#ENZIAN provides a comprehensive and reproducible form of lesion distribution, extent of disease and surgical complexity. It can be a unique language of communication amongst radiologists, clinicians and surgeons.