title: Safety and effect on quality of life of laparoscopic Douglasectomy with radical excision for deeply infiltrating endometriosis in the cul-de-sac.
abstract: OBJECTIVE
  To evaluate the safety and effects on health-related quality of life (HRQOL) of radical excision of deeply infiltrating endometriosis (DIE) in the cul-de-sac.
  
  
  METHODS
  This study included 390 patients with pathologically proven DIE in the cul-de-sac who underwent laparoscopic surgery between January 2000 and December 2011. The preoperative and postoperative visual analog scale (VAS) pain scores and HRQOL data from the 36-item Short Form (SF-36) questionnaire were recorded in 343 patients. Surgical outcomes, complications, and HRQOL were compared between patients who underwent hysterectomy and those who did not. Data were analyzed using the paired t test, Student's t test, and Pearson's correlation analysis.
  
  
  RESULTS
  In the group overall, the VAS pain score and all SF-36 scales improved after surgery. In patients who underwent hysterectomy, all SF-36 scales improved except physical functioning, role-physical, general health, and vitality. In patients who did not undergo hysterectomy, all SF-36 scales improved except general health. There were significant associations between gonadotropin-releasing hormone agonist therapy and SF-36 mental health, SF-36 mental component summary, and oral medication use. The VAS pain score and SF-36 body pain score showed the greatest improvement, and the SF-36 general health score showed the least improvement. Patients who underwent hysterectomy had more severe disease and poorer surgical outcomes than those who did not undergo hysterectomy.
  
  
  CONCLUSIONS
  Laparoscopic radical excision of DIE in the cul-de-sac is safe and significantly improves HRQOL, especially in terms of pain. The severity of endometriosis may affect the degree of improvement in HRQOL scores.
authors.affiliation: Department of Obstetrics and Gynecology, Kyungpook National University Medical Center , Graduate School of Medicine, Daegu, South Korea .
authors.forename: Dae Gy
authors.initials: DG
authors.lastname: Hong
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Lee
authors.forename: Gun Oh
authors.initials: GO
authors.lastname: Chong
authors.forename: Young Lae
authors.initials: YL
authors.lastname: Cho
authors.forename: Yoon Soon
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D010147:Pain Measurement; D059035:Perioperative Period; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome