Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain

Maria Elisabetta Coccia, Coccia ME, Francesca Rizzello, Rizzello F, Antonio Palagiano, Palagiano A, Gianfranco Scarselli, Scarselli G
European journal of obstetrics, gynecology, and reproductive biology · 2011 · vol. 157(1) , pp. 78–83 · doi:10.1016/j.ejogrb.2011.02.008 · PMID:21481523 · W2045468606
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This study analyzed long-term outcomes after laparoscopic endometriosis treatment to identify factors predicting lesion recurrence and pain persistence.

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Abstract

ObjectiveTo investigate factors that might influence the recurrence of both painful symptoms and endometriotic lesions following laparoscopic treatment of endometriosis.Study designRetrospective cohort study in a University teaching hospital. We reviewed data from patients referred for laparoscopy between March 1993 and November 2007. We selected women who were followed up throughout Transvaginal-ultrasound (TV-US) after a first conservative laparoscopy for endometriosis. After laparoscopy, all patients were followed up according to an internal protocol: a standard gynaecologic examination, the assessment of painful symptoms and a TV-US scan that were repeated at 3, 6, and 12 months, and subsequently on a yearly basis. Sixteen factors were assessed by univariable and multivariable Cox proportional hazards models to evaluate their associations with recurrence of endometriotic lesions and pain related-endometriosis.Results401 women were enrolled. A total of 154 (38.4%) experienced moderate or severe pain after laparoscopy; endometriotic lesions were observed by TV-US in 74 (18.4%) patients. In the multivariable model, age at menarche, severity of chronic pelvic pain (CPP) and dysmenorrhoea prior to surgery were significant risk factors for recurrence/occurrence of pain. Age at the first laparoscopy, stage of disease, pre-operative severity of CPP, and pregnancy were predictive factors of the recurrence for such lesions.ConclusionThe severity of CPP prior to the first laparoscopy showed the only significant factor in the overall prediction of recurrence of pain and endometriotic lesions. Patients with severe CPP at the time of their first surgery might represent a sub-group of women with a more aggressive form of endometriosis.

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Condition tags

dysmenorrheaendometriosischronic_pelvic_pain

MeSH descriptors

Dysmenorrhea Endometriosis Laparoscopy Pelvic Pain Postoperative Complications Adult Cohort Studies Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Hospitals, University Humans Italy Italy Laparoscopy

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