title: Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate the efficacy of laparoscopic resection of the uterosacral ligaments in women with endometriosis and predominantly midline dysmenorrhea.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Two academic departments. One hundred eighty patients undergoing operative laparoscopy as first-line therapy for stage I to IV symptomatic endometriosis.
  
  
  METHODS
  Operative laparoscopy including uterosacral ligament resection or conservative surgery alone.
  
  
  METHODS
  Proportion of women with recurrence of moderate or severe dysmenorrhea 1 year after surgery.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Reproductive Surgery Unit, First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy. paolo.vercellini@unimi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Aimi
authors.forename: Mauro
authors.initials: M
authors.lastname: Busacca
authors.forename: Giovanni
authors.initials: G
authors.lastname: Apolone
authors.forename: Anna
authors.initials: A
authors.lastname: Uglietti
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Crosignani
mesh_terms: D000328:Adult; D003075:Coitus; D004412:Dysmenorrhea / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D004715:Endometriosis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery*; D008603:Mental Health; D010166:Palliative Care; D011788:Quality of Life; D012008:Recurrence; D012447:Sacrum; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D014599:Uterus