Objective To investigate the characteristics and trends of surgical management on endometriosis in Peking Union Medical College Hospital From 1983 to 2009. Methods The medical documents of patients with endometriosis diagnosed by surgical pathology were studied retrospectively in Peking Union Medical College Hospital (PUMCH). The ratio of different surgical approaches (laparoscopic and laparotomic surgery) and surgical categories (conservative, semi-radical or radical surgery) were compared in all the cases with endometriosis to investigated alterations trends of approaches and methods of surgery. Results Totally integrated records of 13 972 patients underwent surgeries on endometriosis were reviewed and consisted of 24. 974% (13 972/55 945) of all gynecologic surgeries. 59. 490% of cases (8312/13 972) were treated by laparoscopic approach, which were significantly higher than the rate of 37.700%(15 824/41 973) of laparoscopic approaches in the other gynecologic diseases (P<0.01). The proportion of laparoscopic surgeries in all endometriosis surgery was 67.31% (947/1407) between 2005 and 2009, which were significantly higher than 55. 98% (510/911) of laparoscopic surgeries between 2000 and 2004 (P<0.01). Conservative surgery (i.e.,with uterus and ovaries intact) consisted of 64. 014%(8663/13 533) of endometriosis surgeries. The proportion of conservative surgeries was 66. 24% (4176/6304) between 2005 and 2009. The proportion of laparoscopic approaches consisted of 81.10% (7026/8663) of conservative surgeries and 26. 30% (1281/4870) of semi-radical or radical surgeries (P<0.01).The average number of annual surgeries, the average number of annual laparoscopic surgeries and its proportion in endometriosis, and the average number of annual conservative surgeries and its proportion in pelvic endometriosis between 2005 -2009 were all increased significantly than those at range of 1983 to 1999 and 2000 to 2004. The rate of severe complication 0. 351% (49/13 972) was observed in all endometriosis surgeries. Conclusion Surgery was the major treatment of endometriosis in PUMCH, laparoscopic surgery was the major approach and conservative surgery was the major surgery type.