Patient Perception and Experience of Laparoscopic Excision Versus Ablation of Endometriosis: A Crowd-Sourced Comparative Evaluation of Symptom and Quality of Life Outcomes

STUDY OBJECTIVE: To compare laparoscopic Ablation and Excision in terms of symptom and Quality of Life outcomes as perceived by endometriosis patients. DESIGN: A Cohort, Method comparison Questionnaire-based study. SETTING: Endometriosis-focused Social Media site. PATIENTS: Endometriosis patients with history of Laparoscopic Ablation and Excision. INTERVENTIONS: On-line questionnaire focused on pre and post procedure (ablation and excision) outcomes across 63 measures in 5 realms: Physical Symptoms, Functional Impact, Psycho-emotional Impact, Social/Sexual Impact, Economic/Educational Impact. MEASUREMENTS AND MAIN RESULTS: Two hundred and thirty-two respondents with surgical history that included laparoscopic ablation and excision (without concomitant or interposed hysterectomy) identified for ablation only physical symptom improvement of 11.3% and 8.5% for dysmenorrhea and menorrhagia respectively. Ablation provided no significant improvement in any other physical symptom measure. Excision was identified as providing improvements across all symptoms, ranging from 28% to 46%. In terms of functional Impact, ablation provided non-significant improvements or worsening of status. Excision demonstrated significant improvement for patients across most measures of Functional Impact. In terms of Psycho-emotional Impact, a worsening of quality of life status is identified in 23 of 24 measures following ablation. Excision demonstrated improvement in 22 of 24 measures. For Social-Sexual Impact, ablation resulted in worsened status across all measures, with excision demonstrating improvements in all measures, significantly so in most. For Economic/Educational Impact, significant worsening of measures or insignificant improvements were demonstrated following ablation. Excision demonstrated significant improvement in most measures. In all realms, pre-Excision status was worse than pre-Ablation. Allowing for a more focused comparison of ablation and excision, 113 respondents with a surgical history of ablation sequentially followed by excision demonstrated outcomes similar to the larger group: overall worsening of status resulting from ablation and overall improvement in status following excision with pre-Excision morbidity higher than pre-Ablation. CONCLUSION: In this cohort of patients undergoing laparoscopic endometriosis excision after having undergone endometriosis ablation, the former demonstrated greater beneficial effects over a broad spectrum of symptoms and quality of life measures.