Abstract: Objective To compare the clinical outcomes in patients withⅢ-Ⅳ pelvic endometriosis after laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Methods Clinical data about 256 patients who underwent hysterectomy for severe endometriosis in our department from October 1, 2005 to October 1, 2013 were retrospectively analyzed. The patients who were 43.50±4.65 years old and 42.61±4.84 years old, respectively, were divided into LH group (n=161) and AH group (n=95).Their general information and clinical manifestations before operation, surgical outcomes and postoperative complications were compared. Results The operation time was 158.44±43.13 min and 210.56±31.48 min, respectively, for two groups (P< 0.001). The estimated blood loss in two groups was 288.75±202.64 ml and 841.67±516.28 ml, respectively (P< 0.001). The postoperative hospital stay time of two groups was 6.15±2.02 d and 9.28±3.18 d, respectively (P< 0.001). The incidence of complications was 12.42% and 55.79%, respectively, in two groups (P< 0.001). Conclusion LH is a safe, effective and feasible procedure for Ⅲ-Ⅳ pelvic endometriosis due to its advantages of less trauma, fewer complications and rapid postoperative recovery.