Evaluation of Endometriosis-Associated Pain Scores and Complications after Laparoscopic Surgery in Patients Unresponsive to Medical Treatment

Hale Ankara Aktaş, Murat Levent Dereli, Gülfem Başol, Fatih Şanlıkan, Yasmin Aboalhasan, Esra Keleş, Gazi Yıldız, Emre Mat
In: Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi · 2026 · vol. 13(2) , pp. 141–148 · doi:10.47572/muskutd.1851819 · W7204459167
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Laparoscopic surgery significantly improved pelvic pain in 82 patients with drug-refractory endometriosis, with similar symptom relief across isolated ovarian and deep infiltrating disease groups despite higher intraoperative morbidity in the latter.

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This retrospective study evaluated pain outcomes and surgical complications in patients with endometriosis who remained symptomatic despite prior medical management. The researchers analyzed clinical data to assess the efficacy of laparoscopic excision surgery as a subsequent treatment option for this specific patient population. Key findings indicated that while surgical intervention provided significant pain relief, the procedure carried inherent risks of postoperative complications that required careful monitoring. This paper is centrally about endometriosis — specifically assessing the impact of laparoscopic surgery on pain scores in patients unresponsive to initial medical therapies.

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Abstract

Endometriosis is a chronic gynecologic disorder characterized by the presence of endometrial-like tissue outside the uterus, often associated with pelvic pain and infertility. Although several medical treatments exist, many patients experience persistent symptoms that require surgical management. Painful pelvic symptoms are the main reason why women with endometriosis who do not respond to medical options seek treatment. This study aimed to evaluate changes in pelvic pain symptoms before and after laparoscopic endometriosis surgery in patients unresponsive to medication. Medical records of women who underwent laparoscopic surgery for drug-refractory painful pelvic symptoms at a tertiary referral hospital between January 1, 2018, and September 30, 2020, were retrospectively reviewed. A total of 82 eligible participants were included. Patients were categorized as isolated ovarian endometriosis (group 1, n=51) or deep infiltrating endometriosis (group 2, n=31). The groups were compared for changes in visual analogue scale (VAS) scores and perioperative outcomes. Composite intraoperative and postoperative morbidities were analyzed as primary outcome measures, including transfusion requirements and other surgery-related conditions. Laparoscopic endometriosis surgery provided significant pain relief for all pelvic pain symptoms. The degree of postoperative VAS improvement was similar between groups, indicating that symptom improvement was independent of disease localization. Composite intraoperative morbidities were significantly higher in group 2, whereas postoperative morbidities showed no significant difference (p=0.001 and p=0.086, respectively). Laparoscopic endometriosis surgery when performed by experienced surgeons, provides substantial improvement in pelvic pain symptoms. Treatment should be individualized using a patient-centered, multimodal, and interdisciplinary approach.
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References

- Tomassetti C, Johnson NP, Petrozza J, et al. An international terminology for endometriosis, 2021. J Minim Invasive Gynecol. 2021;28(11):1849-1859. - Sengul D, Sengul I, Soares Junior JM. Caesarean section scar endometriosis: quo vadis? Rev Assoc Med Bras (1992). 2022;68(1):1-2. - McKee DC, Mansour T, Wasson MN. Thoracic and diaphragmatic endometriosis: an overview of diagnosis and surgical treatment. Curr Opin Obstet Gynecol. 2022;34(4):204-209. - Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. - Baușic A, Coroleucă C, Coroleucă C, et al. Transvaginal ultrasound vs. magnetic resonance imaging (MRI) value in endometriosis diagnosis. Diagnostics (Basel). 2022;12(7):1767. - Nisenblat V, Bossuyt PM, Farquhar C, et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2:CD009591. - American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817-821. - Chapman JR, Norvell DC, Hermsmeyer JT, et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976). 2011;36(21 Suppl):S54-S68. Details Primary Language English Subjects Clinical Sciences (Other) Journal Section Research Article Authors Gülfem Başol 0000-0001-7738-8531 Türkiye Fatih Şanlıkan 0000-0002-3166-7129 Türkiye Esra Keles 0000-0001-8099-8883 Türkiye Gazi Yıldız 0000-0003-2546-009X Türkiye Emre Mat 0000-0002-3965-543X Türkiye Publication Date August 27, 2026 Submission Date December 30, 2025 Acceptance Date June 8, 2026 Published in Issue Year 2026 Volume: 13 Number: 2

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