Background <p>Endometriosis is a chronic inflammatory disease significantly affecting women's health and quality of life. The recent evidence highlights the role of gut microbiota dysbiosis in endometriosis pathogenesis, suggesting that gut microbiota modulation could be a promising therapeutic strategy.</p> Objectives <p>This study aimed to retrospectively evaluate the therapeutic efficacy of microecological therapy, via the modulation of gut microbiota, inflammatory and immune parameters, as an adjunct treatment for patients with endometriosis undergoing laparoscopic surgery.</p> Methods <p>A retrospective analysis was conducted on 187 patients diagnosed with endometriosis from January 2022 to December 2023. Patients were grouped into a surgery-only group and a surgery-plus-microecological therapy group. Clinical outcomes including gastrointestinal recovery, postoperative complications, and pain were recorded. Gut microbiota composition, systemic inflammation markers, estradiol levels, intestinal barrier function (lipopolysaccharide, LPS), and intestinal mucosal immunity were also analyzed.</p> Results <p>Patients receiving microecological therapy showed significantly improved gastrointestinal recovery, decreased postoperative pain, reduced complication rates, and enhanced quality of life compared with surgery-only controls. Microecological therapy notably reduced systemic inflammation, as evidenced by lower serum IL-6, TNF-α, and LPS levels, and decreased estradiol concentrations, and significantly increased beneficial gut microbiota abundance and improved mucosal immunity markers.</p> Conclusion <p>Microecological therapy effectively enhances postoperative outcomes, reduces systemic inflammation, restores gut microbiota balance, and strengthens intestinal mucosal immunity in endometriosis patients.</p>