Surgical Treatment of Endometriosis in Private Practice: Cohort Study with Mean Follow-up of 3 Years

Jose Daniel Roman, Jose D Roman, Roman JD
Journal of Minimally Invasive Gynecology · 2010 · vol. 17(1) , pp. 42–46 · doi:10.1016/j.jmig.2009.09.019 · PMID:20129331 · W1983683105
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This cohort study evaluated the surgical treatment of endometriosis in a private practice setting, reporting outcomes over a mean follow-up period of three years.

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Abstract

Study objectiveTo describe our experience with surgical treatment of endometriosis.DesignObservational cohort study (Canadian Task Force classification II-2).SettingPrivate hospital.PatientsOne hundred sixty-three patients with histologically confirmed endometriosis who had completed a preoperative questionnaire, had available intraoperative findings and photographic documentation, and had been followed up to 6 years.InterventionLaparoscopic electrosurgical excision of endometriotic implants.Measurements and main resultsPatients completed a visual analogue scale (VAS) for 6 components of endometriosis-related symptoms. The EuroQol Group EQ-5D questionnaire was used for evaluation of quality of life. Long-term follow up was performed using a questionnaire and review of patient medical records. Mean (SD; 95% confidence interval) patient age at surgery was 31.01 (8.5; 29.7-32.3) years. The primary symptom at initial consultation was dysmenorrhea in 94 patients (57.67%, nonmenstrual pelvic pain in 44 (27%), dyspareunia in 11 (6.75%), menorrhagia in 8 (4.9%), infertility in 4 (2.45%), and pelvic mass in 2 (1.23%). Thirty-three patients (20%) had undergone previous surgery because of endometriosis. At surgery, endometriosis was stage I in 50 patients (30.67%), stage II in 65 (39.88%), stage III in 23 (14.11%), and stage IV in 25 (15.34%). Other surgical procedures performed with the index surgery were cystoscopy in 48 patients (29.45%), laparoscopic ovarian cystectomy in 24 (14.72%), laparoscopic hysterectomy in 15 (9.2%), laparoscopic appendectomy in 9 (5.5%), sigmoidoscopy in 6 (3.68%), laparoscopic oophorectomy in 6 (3.68%), extensive laparoscopic adhesiolysis in 5 (3.07%) bowel resection in 2 (1.25%), laparoscopic myomectomy in 1 (0.61%), and bladder resection in 1 (0.61%). Surgery proceeded to laparotomy in 6 patients (3.68%). Major surgical complications included bowel perforation, severe pelvic pain 1 week after laparoscopic excision, and temporary numbness of the right side of the perineum in 1 patient each. Minor postoperative complications included urinary tract infection in 3 patients and port site infections that resolved with oral antibiotic therapy in 2 patients. Follow-up was 37.82 (20.09; 34.74-40.92) months. Surgical excision of endometriosis had a positive effect on endometriosis-related symptoms. Four pain scores were reduced, with statistically significant differences (p<.001 and p<.05): dysmenorrhea, pelvic pain not related to menstruation, dyspareunia, and dyschezia. The positive effect of surgical excision on patient quality of life was demonstrated by a statistically significant difference on the EQ-5D index (p<.001) and the EQ-5D VAS (p<.001). Thirty-two (20%) patients underwent a second procedure after the index surgery. Endometriosis stage affects the probability of requiring further surgery because of recurrent symptoms. There was evidence of endometriosis at histologic analysis in only 13 (40.62%) patients who required further surgery.ConclusionLaparoscopic excision of endometriosis significantly reduces pain and improves quality of life as measured by both the EQ-5D index and the EQ-5D VAS, with a low complication rate.

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Condition tags

dysmenorrheaendometriosischronic_pelvic_pain

MeSH descriptors

Adnexal Diseases Endometriosis Adnexal Diseases Adnexal Diseases Adult Cohort Studies Dysmenorrhea Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Female Follow-Up Studies Gynecologic Surgical Procedures Humans Infertility, Female Infertility, Female Infertility, Female Laparoscopy Menorrhagia

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