Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis

N Manobharath, J Lewin, Jonathan Lewin, M Hirsch, Martin Hirsch, J Naftalin, Arvind Vashisht, A Vashisht, Alfred Cutner, A Cutner, E Saridogan, Ertan Sarıdoğan
Facts, views & vision in ObGyn · 2023 · vol. 15(1) , pp. 35–43 · doi:10.52054/fvvo.15.1.055 · PMID:37010333 · W4362471164
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy resulted in greater improvement in non-cyclical pelvic pain and other symptoms compared to excisional surgery alone.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

The study compared symptom and quality-of-life changes after excisional endometriosis surgery alone versus excisional endometriosis surgery combined with hysterectomy and bilateral salpingo-oophorectomy for pelvic pain associated with deep endometriosis. Using data from a single endometriosis center (2009–2019) in the British Society for Gynaecological Endoscopy database, researchers analyzed pre- and postoperative pain scores and EQ-VAS, with adenomyosis assessed by blinded re-analysis of imaging and/or histology. After controlling for baseline characteristics and adenomyosis, EES-HBSO showed greater improvements than EES alone in non-cyclical pelvic pain and also for dyspareunia, non-cyclical dyschaezia, and bladder pain, with quality-of-life improvement no longer statistically significant after adjusting for adenomyosis. This paper is centrally about endometriosis—specifically comparing excisional surgery alone versus excisional surgery plus hysterectomy and BSO for deep endometriosis–associated pelvic pain.

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Abstract

Background: There is no agreed consensus on the optimal surgical treatment for pain associated with endometriosis. Objectives: To compare improvement in symptoms and quality-of-life in patients undergoing excisional endometriosis surgery (EES) versus EES with hysterectomy and bilateral salpingo-oophorectomy (EES-HBSO). Methods: This study evaluated patients undergoing EES and EES-HBSO at a single endometriosis centre between 2009 and 2019. Data was obtained from the British Society for Gynaecological Endoscopy database. Adenomyosis was assessed by blinded re-analysis of imaging and/or histology data. Main outcome measures: Pain scores (numeric rating scale 0-10) and quality-of-life scores (EQ-VAS) before and after EES and EES-HBSO. Results: We included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis. Conclusion: EES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.
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Abstract

Background There is no agreed consensus on the optimal surgical treatment for pain associated with endometriosis.

Objectives

To compare improvement in symptoms and quality-of-life in patients undergoing excisional endometriosis surgery (EES) versus EES with hysterectomy and bilateral salpingo-oophorectomy (EES-HBSO).

Methods

This study evaluated patients undergoing EES and EES-HBSO at a single endometriosis centre between 2009 and 2019. Data was obtained from the British Society for Gynaecological Endoscopy database. Adenomyosis was assessed by blinded re-analysis of imaging and/or histology data. Main outcome measures Pain scores (numeric rating scale 0-10) and quality-of-life scores (EQ-VAS) before and after EES and EES-HBSO.

Results

We included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis.

Conclusion

EES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.

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Outcome instruments

VAS-pain

Condition tags

endometriosisadenomyosisdyspareunia

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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