Cohort study on outcomes of laparoscopic endometriosis surgery

Is laparoscopic endometriosis surgery effective?

Key Points

Highlight:

• This is a six-year study on the surgical outcomes of laparoscopic endometriosis surgery.

Importance:

• Surgical treatment seems to be an effective treatment, can reduce the possibility of recurrence.

What's done here:

• A cohort study consisting of 1315 patients with endometriosis undergoing laparoscopic surgery with follow-up of 6 to 72 months.
• 1086 (82.5%) were in stage III, and IV endometriosis; 968 (73.61%) had endometrioma with or without deep infiltrative endometriosis (DIE) or peritoneal involvement; and 347 (26.39%) had either DIE or peritoneal involvement without endometrioma.

Data:

Following surgery

• The pain visual analog scale (VAS) score decreased from 8.23 ± 2.03 to 4.46 ± 2.47 in 93.07% of patients.
• Sixty-six (33.1%) infertility had a spontaneous pregnancy, and 15 (25%) became pregnant using intrauterine insemination or assisted reproductive technique postoperatively.
• Fifty-three patients (6.56%) required reoperation.

Limitations:

Lack of comparison group in this retrospective cohort study makes it difficult to deduce the relative usefulness of laparoscopic endometriosis surgery as compared to other intervention.

Lay Summary

Laparoscopic surgery followed by histological confirmation is considered a standard for diagnosis, staging, and treatment of endometriosis. Radical and conservative surgical approaches are often required for the removal of endometriotic lesions in the case of vaginal or rectal wall deep infiltrative endometriosis, as well as for removal of bowel or bladder endometriosis. The high recurrence of pain and ovarian endometriomas are of most concern post-surgical treatment. This study aimed to investigate the effect of total resection of endometriosis lesions by laparoscopy on pain reduction, recurrence, and improvement of infertility in women diagnosed Shiraz University of Medical Sciences.

A cohort of 1315 patients diagnosed with endometriosis and underwent laparoscopic surgery between April 2010 and April 2016 was investigated over a period of 6 to 72 months using data from medical records. There were 1086 (82.5%) of women with stage III and IV endometriosis, 968 (73.61%) had endometrioma with or without DIE or peritoneal involvement, and 347 (26.39%) of patients had either DIE or peritoneal involvement without endometrioma. From these patients, the authors observed the significantly higher proportion of unilateral endometrioma in the left ovary. In addition, one hundred and thirty-three (10.7%) rectal wall, 7 (0.32%) sigmoid colon, 4 (0.18%) vagina, 125 (5.6%) ureter and 33 (1.52) bladder endometriosis involvement were detected.

The results showed good efficacy over the four years’ follow-up period, as 93.07% of pain scores improved, 6.14% remained unchanged, and 0.78% became worse. Regarding pregnancy outcome, sixty-six (33.1%) infertile women had a spontaneous pregnancy, and 15 (25%) became pregnant using intrauterine insemination or assisted reproductive technique postoperatively.

In conclusion, these data suggested that operative laparoscopy, when performed well, can be considered as a highly effective method for treatment of advanced endometriosis in particular for women with pelvic pain. Lack of comparison group in this retrospective cohort study limits the interpretation relative to other available interventions for endometriosis such as the inclusion of medications.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28760003