title: Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women.
abstract: OBJECTIVE
  What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women?
  
  
  CONCLUSIONS
  Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery.
  
  
  BACKGROUND
  The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before. However, previous studies focus on medical benchmarks without including the patient's perspective in a quantitative manner.
  
  
  METHODS
  A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013.
  
  
  METHODS
  Women diagnosed with endometriosis and with at least one specific laparoscopic surgery in the past were enrolled in the study. The study investigated the effect of the minimally invasive surgery on health and on quality of work life of affected women. Questions used were obtained from the World Endometriosis Research Foundation (WERF) Global Study on Women's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study.
  
  
  RESULTS
  Of the 587 women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%) were included in the study. Our data show that 62% (n = 130) of the study population declared endometriosis as influencing the job during the period prior to surgery, compared with 28% after surgery (P < 0.001). The mean (maximal) absence from work due to endometriosis was reduced from 2.0 (4.9) to 0.5 (1.4) hours per week (P < 0.001). The mean (maximal) loss in working performance after the surgery averaged out at 5.7% (12.6%) compared with 17.5% (30.5%) before this treatment (P < 0.001).
  
  
  CONCLUSIONS
  The mediocre response rate of the study weakens the representativeness of the investigated population. Considering the anonymous setting a non-responder investigation was not performed. A bias due to selection, information and negativity effects within a retrospective survey cannot be excluded, although study-sensitive questions were provided in multiple ways. The absence of a control group (sham group; e.g. patients undergoing specific diagnostic laparoscopy without treatment) is a further limitation of the study.
  
  
  CONCLUSIONS
  Our study shows that indicated minimally invasive surgery has a clear positive effect on the wellbeing and working performance of women suffering from moderate to severe endometriosis. Furthermore, national net savings in indirect costs with the present number of surgeries is estimated to be €10.7 million per year. In an idealized setting (i.e. without any diagnosis delay) this figure could be more than doubled.
  
  
  BACKGROUND
  The study was performed on behalf of the University Hospital of Bern (Inselspital) as one of the leading Swiss tertiary care centers. The authors do not declare any competing interests.
authors.affiliation: Department of Physiology, University of Bern, 3012 Bern, Switzerland marcel.wullschleger@alumni.unisg.ch.
authors.forename: M F
authors.initials: MF
authors.lastname: Wullschleger
authors.affiliation: Department of Obstetrics and Gynecology, University of Bern, 3010 Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Imboden
authors.affiliation: Department of Obstetrics and Gynecology, University of Bern, 3010 Bern, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wanner
authors.affiliation: Department of Obstetrics and Gynecology, University of Bern, 3010 Bern, Switzerland.
authors.forename: M D
authors.initials: MD
authors.lastname: Mueller
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D014937:Work
keywords: endometriosis; health economics; national retrospective study; quality of life