Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial

Paolo Vercellini, Aimi G, Giorgio Aimi, Busacca M, Mauro Busacca, Giovanni Apolone, Anna Uglietti, Uglietti A, Crosignani PG, Pier Giorgio Crosignani
Fertility and sterility · 2003 · vol. 80(2) , pp. 310–319 · doi:10.1016/s0015-0282(03)00613-7 · PMID:12909493 · W1969813073
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This randomized controlled trial compared laparoscopic uterosacral ligament resection to expectant management for dysmenorrhea in women with endometriosis, reporting on patient outcomes.

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Abstract

ObjectiveTo evaluate the efficacy of laparoscopic resection of the uterosacral ligaments in women with endometriosis and predominantly midline dysmenorrhea.DesignRandomized controlled trial.SettingTwo academic departments. One hundred eighty patients undergoing operative laparoscopy as first-line therapy for stage I to IV symptomatic endometriosis.Intervention(s)Operative laparoscopy including uterosacral ligament resection or conservative surgery alone.Main outcome measure(s)Proportion of women with recurrence of moderate or severe dysmenorrhea 1 year after surgery.Result(s)No complications occurred. Among the patients who were evaluable 1 year after operative laparoscopy, 23 of 78 (29%) women who had uterosacral ligament resection and 21 of 78 (27%) women who had conservative surgery only reported recurrent dysmenorrhea. The corresponding numbers of patients at 3 years were 21 of 59 (36%) women and 18 of 57 (32%) women, respectively. Time to recurrence was similar in the two groups. Pain was substantially reduced, and patients in both groups experienced similar and significant improvements in health-related quality of life, psychiatric profile, and sexual satisfaction. Overall, 68 of 90 (75%) patients in the uterosacral ligament resection group and 67 of 90 (74%) patients in the conservative surgery group were satisfied at 1 year.Conclusion(s)Addition of uterosacral ligament resection to conservative laparoscopic surgery for endometriosis did not reduce the medium- or long-term frequency and severity of recurrence of dysmenorrhea.

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Condition tags

dysmenorrheaendometriosis

MeSH descriptors

Dysmenorrhea Dysmenorrhea Endometriosis Laparoscopy Ligaments Adult Coitus Dysmenorrhea Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Female Health Status Humans Ligaments Mental Health Palliative Care Quality of Life Recurrence

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