To excise or ablate endometriosis? A prospective randomized double-blinded trial after 5-year follow-up.
OBJECTIVE
To compare reduction of pain after laparoscopy for ablation or excision of endometriosis.


METHODS
Prospective, randomized, double-blind study (Canadian Task Force classification I).


METHODS
Endometriosis and pelvic pain clinic at a university teaching hospital.


METHODS
Women of reproductive age with pelvic pain and visually proved endometriosis.


METHODS
Subjects completed a questionnaire rating various kinds of pain using visual analog scales (VAS). After visual identification subjects were randomized to treatment via ablation or excision by supervised training gynecologists as primary surgeons. Follow-up questionnaires documented pain levels every 3 months for 1 year and then every 6 months for 5 years.


RESULTS
Change in pain VAS scores during 5 years after the operation and rates of pregnancy, repeat surgery, and use of hormone therapy were evaluated. There was a reduction in all pain scores over the 5-year follow-up in both treatment groups. A significantly greater reduction in dyspareunia VAS scores was observed in the excision group at 5 years (p = .03 at univariate analysis, and p = .007 at multivariate analysis). More women in the ablation group continued to receive medical treatment of endometriosis at 5 years (p = .004).


CONCLUSIONS
Surgical treatment of endometriosis provides symptom reduction for up to 5 years. In some limited areas such as deep dyspareunia, excision is more effective than ablation.
Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia; Department Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: kathandmutt@bigpond.com.
Martin
M
Healey
Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Claudia
C
Cheng
Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Harvinder
H
Kaur
D000293:Adolescent; D000328:Adult; D002170:Canada; D004311:Double-Blind Method; D004414:Dyspareunia / Q000209:etiology / Q000503:physiopathology; D055356:Endometrial Ablation Techniques; D004715:Endometriosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D012086:Reoperation; D011795:Surveys and Questionnaires; D055815:Young Adult
Ablation; Endometriosis; Excision; Laparoscopy; Pelvic pain