Laparoscopic excision of endometriosis: A randomized, placebo-controlled trial

Abbott J, Jason Abbott, Hawe J, Jed Hawe, Hunter D, David Hunter, Holmes M, Michael Holmes, Finn P, Paul Finn, Garry R, Ray Garry
Fertility and sterility · 2004 · vol. 82(4) , pp. 878–884 · doi:10.1016/j.fertnstert.2004.03.046 · PMID:15482763 · W2008012097
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This randomized, placebo-controlled trial investigated the efficacy of laparoscopic excision for endometriosis.

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Abstract

ObjectiveTo examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery compared with placebo surgery.DesignA randomized, blinded, crossover study.SettingA tertiary referral unit in a district general hospital.Patient(s)Thirty-nine women with histologically proven endometriosis completed the 12-month study.Intervention(s)Women were randomized to receive initially either a diagnostic procedure (the delayed surgical group) or full excisional surgery (the immediate surgery group). After 6 months, repeat laparoscopy was performed, with removal of any pathology present.Main outcome measure(s)The end points were changes from baseline values of visual analogue pain scores, validated quality-of-life instruments (EQ-5D and SF-12), and sexual activity questionnaire scores. Patients and assessors of outcomes were blinded to the treatment-group assignment.Result(s)Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo: 16 of 20 (80%) vs. 6 of 19 (32%); chi(2)(1) = 9.3. Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo. Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45% of cases, with disease remaining static in 33% and improving in 22% of cases. Nonresponsiveness to surgery was reported in 20% of cases.Conclusion(s)Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life. Surgery is associated with a 30% placebo response rate that is not dependent on severity of disease. Approximately 20% of women do not report an improvement after surgery for endometriosis.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Adult Cross-Over Studies Endometriosis Endometriosis Female Humans Laparoscopy Laparoscopy Pelvic Pain Pelvic Pain Placebos Pregnancy Pregnancy Rate Quality of Life

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References (33)

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