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

OBJECTIVE: To evaluate the efficacy of laparoscopic resection of the uterosacral ligaments in women with endometriosis and predominantly midline dysmenorrhea. DESIGN: Randomized controlled trial. SETTING: Two 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 Laparoscopy Ligaments Adult Adult Coitus Coitus Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Endometriosis Female Female Health Status

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