A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage III-IV endometriosis.
OBJECTIVE
To investigate the role of adjuvant treatment with gonadotropin-releasing-hormone agonist (GnRHa) following conservative surgical treatment of endometriosis.


METHODS
Sixty patients in the reproductive age (mean age 28.6 years), with symptomatic stages III and IV endometriosis following laparoscopic surgery and without previous hormonal treatment were enrolled in a prospective, randomized, controlled trial to compare the effects of 3-month treatment with triptorelin depot-3.75 i.m. (30 patients) versus expectant management using placebo injection (30 patients).


RESULTS
Six patients (one in triptorelin group and five in placebo group) were lost at follow-up, the remaining 54 were suitable for analysis. Pelvic pain persistence or recurrence, endometrioma relapses and pregnancy rate were evaluated during a 5-year follow-up. The results of 29 cases treated with triptorelin and 25 that received placebo did not show significant differences in pain recurrence (P=1, RR=0.94, 95% CI=0.57-1.55), endometrioma relapse (P=0.67, RR=1.29, 95% CI=0.66-2.50), and pregnancy rate in infertile women (P=0.80, RR=0.81, 95% CI=0.37-1.80). Curves of time of pain recurrence and pregnancy during 5-year follow-up did not show significant differences between the two groups (P=0.79 and P=0.51, respectively, using Mantel-Haenzsel logrank test).


CONCLUSIONS
Triptorelin treatment after operative laparoscopy for stage III/IV endometriosis does not appear to be superior to expectant management in terms of prevention of symptoms recurrence and endometrioma relapse, and has no influence on pregnancy rate in endometriosis-associated infertility.
Loverro
Giuseppe
G
Department of Gynecology, Obstetrics, and Neonatology, University of Bari, Italy.
Carriero
Carmine
C
Rossi
A Cristina
AC
Putignano
Giuseppe
G
Nicolardi
Vittorio
V
Selvaggi
Luigi
L
D000328:Adult; D017024:Chemotherapy, Adjuvant; D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005298:Fertility / Q000187:drug effects*; D006801:Humans; D010535:Laparoscopy; D008186:Luteolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D055502:Secondary Prevention; D017329:Triptorelin Pamoate / Q000494:pharmacology / Q000627:therapeutic use*
D008186:Luteolytic Agents; D017329:Triptorelin Pamoate