Operative management of deeply infiltrating endometriosis: Results on pelvic pain symptoms according to a surgical classification

Chopin N, ChopinNicolas, Nicolás Chopin, Nicolas Chopin, Vieira M, Marco Vieira, Borghese B, Bruno Borghese, Foulot H, H. Foulot, Hervé Foulot, Bertrand Dousset, B. Dousset, Coste J, Jöel Coste, Alexandre Mignon, Mignon A, Arnaud Fauconnier, Fauconnier A, Charles Chapron, Chapron C
Journal of Minimally Invasive Gynecology · 2005 · vol. 12(2) , pp. 106–112 · doi:10.1016/j.jmig.2005.01.015 · PMID:15904612 · W2114640459
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This study investigated the impact of surgical management for deeply infiltrating endometriosis on pelvic pain symptoms, correlating outcomes with a surgical classification system.

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Abstract

Study objectiveTo assess the results of complete surgical excision for patients with painful functional symptoms in a context of histologically proven deeply infiltrating endometriosis (DIE).DesignRetrospective analysis (Canadian Task Force classification II-2).SettingUniversity-affiliated hospital.PatientsOne hundred thirty-two patients with pelvic pain symptoms and histologically proved DIE. The DIE lesions were classified according to surgical classification: uterosacral ligaments (USL), vagina, bladder, or intestine.InterventionComplete surgical excision of DIE lesions.Measurements and main resultsA retrospective analysis was made of medical, operative, and pathologic reports as well as of questionnaires mailed to patients. Efficiency of surgical excision was assessed according to two methods: objective evaluation (numerical rating scale) and subjective evaluation (patients were asked to classify the improvement after surgery with one of the following: excellent, satisfactory, slight, or no improvement). For each symptom, the mean scores according to the numerical rating scale were significantly lower postoperatively. The difference between the preoperative and postoperative scores was 5.2 points +/- 3.6 for dysmenorrhea, 4.6 points +/- 3.1 for deep dyspareunia, 4.4 points +/- 3.7 for painful defecation during menstruation, 4.9 +/- 3.2 for lower urinary tract symptoms during menses, and 4.6 points +/- 3.4 for noncyclic chronic pelvic pain. Comparable results were observed for patients in each group according to the surgical classification of their DIE lesions: USL (n = 78 patients); vagina (n = 25 patients); bladder (n = 13 patients); and intestine (n = 16 patients). Subjective evaluation showed that the improvement was considered to be excellent in 40.2% of women (53 patients), satisfactory in 42.4% (56 patients), slight in 14.4% (19 patients), and nonexistent in 3.0% (4 patients). The patients' characteristics (i.e., age, gravidity, parity, body mass index, preoperative medical treatment, follow-up after surgery, number and location of DIE lesions, revised American Fertility Society stage, associated endometrioma) did not differ significantly according to whether the improvement was considered to be excellent (Group A: 53 patients) or not (Group B: 79 patients). Among the infertile patients (n = 78; 59.1%), there was no difference in pain improvement if the patient was pregnant or not in the 42 women who achieved pregnancy after the surgery.ConclusionComplete surgical excision of DIE lesions results in a statistically significant reduction in painful functional symptoms. These results are observed whatever the main location of DIE lesions. The patients' preoperative characteristics have no significant influence on the result.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Broad Ligament Endometriosis Endometriosis Intestinal Diseases Urinary Bladder Diseases Vaginal Diseases Adult Broad Ligament Broad Ligament Cohort Studies Endometriosis Endometriosis Female Follow-Up Studies Hospitals, University Humans Intestinal Diseases Intestinal Diseases Laparoscopy Laparoscopy

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