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A randomized trial of excision versus ablation for mild endometriosis

  • Jeremy Wright
    Correspondence
    Reprint requests: Jeremy Wright, FRCOG, The Woking Nuffield Hospital, Shores Road, Woking, Surrey GU21 4BY (FAX: +44-1483-724833).
    Affiliations
    Ashford and St. Peter’s NHS Trust, Chertsey; Rotherham General Hospital, Lancs; Great Western Hospital, Swindon; and University of Surrey, Guildford, United Kingdom
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  • Hany Lotfallah
    Affiliations
    Ashford and St. Peter’s NHS Trust, Chertsey; Rotherham General Hospital, Lancs; Great Western Hospital, Swindon; and University of Surrey, Guildford, United Kingdom
    Search for articles by this author
  • Kevin Jones
    Affiliations
    Ashford and St. Peter’s NHS Trust, Chertsey; Rotherham General Hospital, Lancs; Great Western Hospital, Swindon; and University of Surrey, Guildford, United Kingdom
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  • David Lovell
    Affiliations
    Ashford and St. Peter’s NHS Trust, Chertsey; Rotherham General Hospital, Lancs; Great Western Hospital, Swindon; and University of Surrey, Guildford, United Kingdom
    Search for articles by this author

      Objective

      To compare excisional and ablative treatment modalities for mild (revised American Fertility score 1–2) endometriosis in the management of chronic pelvic pain.

      Design

      A randomized study of excision or ablation for mild endometriosis, participants and investigators alike blinded to the treatment modality at the follow-up visit.

      Setting

      District general hospital with a specialist pelvic pain clinic in the United Kingdom.

      Patient(s)

      Women presenting with chronic pelvic pain.

      Intervention(s)

      Participants were asked to complete a questionnaire detailing symptoms related to chronic pelvic pain and rating their pain on a ranked ordinal scale. Areas of pelvic tenderness were identified and similarly ranked. At laparoscopy they were randomly assigned to excision or ablation of any endometriotic lesions, and the questionnaire was repeated at 6 months.

      Main Outcome Measure(s)

      Changes in pain score on a ranked ordinal scale after surgical treatment for mild endometriosis.

      Result(s)

      Both treatment modalities produced good symptomatic relief and reduction of pelvic tenderness (67%). There was no difference in morbidity; one woman in each group became pregnant during the study period. Only two participants reported no relief or a worsening of symptoms or signs.

      Conclusion(s)

      This small study showed good symptom relief at 6 months from pelvic pain for the majority of participants irrespective of the treatment modality, but two participants did not improve or got worse. A high pain score before treatment was a predictor of appreciable improvement. Further work is needed to identify women in whom surgical intervention is likely to produce a good response.

      Key Words

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      References

        • Nisolle M.
        • Paindaveine B.
        • Bourdon A.
        • Berliere M.
        • Casanas-Roux F.
        • Donnez J.
        Histologic study of peritoneal endometriosis in infertile women.
        Fertil Steril. 1990; 53: 984-988
        • Sutton C.J.
        • Pooley A.S.
        • Ewen S.P.
        • Haines P.
        Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis.
        Fertil Steril. 1997; 68: 1070-1074
        • Hasson H.M.
        Electrocoagulation of pelvic endometriotic lesions with laparoscopic control.
        Am J Obstet Gynecol. 1979; 135: 115-121
        • Sutton C.
        • Hill D.
        Laser laparoscopy in the treatment of endometriosis. A 5-year study.
        Br J Obstet Gynaecol. 1990; 97: 181-185
        • Shirk G.J.
        Use of the Nd:YAG laser for the treatment of endometriosis.
        Am J Obstet Gynecol. 1989; 160: 1344-1348
        • Redwine D.B.
        Conservative laparoscopic excision of endometriosis by sharp dissection.
        Fertil Steril. 1991; 56: 628-634
        • Shafik A.
        • Ratcliffe N.
        • Wright J.T.
        The importance of histological diagnosis in patients with chronic pelvic pain and laparoscopic evidence of endometriosis.
        Gynaecol Endosc. 2000; 9: 301-304
        • Candiani G.B.
        • Vercellini P.
        • Fedele L.
        • Colombo A.
        • Candiani M.
        Mild endometriosis and infertility.
        Obstet Gynecol Surv. 1991; 46: 374-382
        • Redwine D.B.
        American Fertility Society classification of endometriosis—the last word?.
        Fertil Steril. 1990; 54: 180-181
        • Redwine D.B.
        Laparoscopic excision of endometriosis with 3-mm scissors.
        J Am Assoc Gynecol Laparosc. 1993; 1: 24-30
        • Redwine D.B.
        Treatment of endometriosis-associated pain.
        in: Olive D.L. Endometriosis infertility and reproductive medicine clinics of North America. Saunders, Philadelphia1992: 697-720
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity.
        Pain. 1986; 27: 117-126
        • Chatfield C.
        • Collins A.J.
        An introduction to multivariate analysis. Chapman & Hall, London1980