Laparoscopic surgery for pelvic pain associated with endometriosis.
OBJECTIVE
To assess the efficacy of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis. The review aims to compare the effectiveness of any laparoscopic procedure versus any other treatment modality, including expectant management.


METHODS
The search strategy of the Menstrual Disorders and Subfertility Review Group was used to identify all publications that described or might have described randomised trials of laparoscopic surgery in the treatment of symptomatic endometriosis. For a full description of the Review Group strategy see the Review Group details.


METHODS
Trials were selected if they were randomised and compared the effectiveness of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis, with other treatment modalities or placebo.


METHODS
One study had data appropriate for inclusion within the review. This study compared laparoscopic laser surgery with diagnostic laparoscopy. Pain relief was the primary outcome measure. The data was extracted independently by two reviewers.


RESULTS
In comparison to expectant treatment there is a significant degree of pain relief at six months after surgery with laser laparoscopic surgery for minimal, mild and moderate endometriosis. Odds Ratio (OR) 4.97, 95% Confidence Interval (CI) 1.85,13.39


CONCLUSIONS
The combined surgical approach of laparoscopic laser ablation, adhesiolysis and uterine nerve ablation is likely to be a beneficial treatment for pelvic pain associated with minimal, mild and moderate endometriosis. As only one trial is included in the analysis, this conclusion should be interpreted with caution.
Jacobson
T Z
TZ
Obstetrics and Gynaecology, John Radcliffe Hospital, Headington, Oxford, UK, OX3 9DU. tal.jacobson@virgin.net
Barlow
D H
DH
Garry
R
R
Koninckx
P
P
D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D053685:Laser Therapy; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D000267:Tissue Adhesions / Q000601:surgery