To excise or ablate endometriosis? A prospective randomized double-blinded trial after 5-year follow-up

Abstract

Study objective: To compare reduction of pain after laparoscopy for ablation or excision of endometriosis.

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

Setting: Endometriosis and pelvic pain clinic at a university teaching hospital.

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

Interventions: 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.

Measurements and main 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.

Keywords: Ablation; Endometriosis; Excision; Laparoscopy; Pelvic pain.