Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial.
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.
Vercellini
Paolo
P
Reproductive Surgery Unit, First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy. paolo.vercellini@unimi.it
Aimi
Giorgio
G
Busacca
Mauro
M
Apolone
Giovanni
G
Uglietti
Anna
A
Crosignani
Pier Giorgio
PG
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