A randomized trial of excision versus ablation for mild endometriosis

Wright, Jeremy; Lotfallah, Hany; Jones, Keisha; Lovell, David P.

doi:10.1016/j.jmig.2005.07.003

Cited by 17 publications

(34 citation statements)

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“…A major finding of this study is the apparent failure of surgical therapy to have a sustained reduction in global pain scores for women with superficial disease, in contrast to the report by Abbott and colleagues [2], which showed good relief at 5 years, and the randomised controlled trial by Wright et al [1], which showed pain relief for 65% of women at 6 months. Abbott and colleagues' cohort did not distinguish between superficial and deep disease or the number requiring hysterectomy, although they did subgroup the data by r-ASRM stage.…”

Section: Discussioncontrasting

confidence: 60%

“…Also, 34% required further surgery, and these patients were still included in the analysis. In the study by Wright et al [1], 6 months as the end point of the randomised trial is probably too early for a definitive assessment to be made of sustained benefit. r-ASRM, unlike most other disease staging systems, is not dependant solely on the disease itself, as it is derived from an assessment of the presence of pelvic adhesions, as well as endometriotic deposits.…”

Section: Discussionmentioning

confidence: 99%

“…It looks at depression by drawing on 12 dimensions: concentration, sleep, usefulness, decision making, psychological strain, coping, enjoyment, unhappiness, ability to face up to problems, self-confidence, worthlessness and happiness. Each dimension is evaluated as either an improvement/unchanged (0) or worsening (1). The overall result is expressed as a numerical score from 0 to 12, with 12 indicating severe depression.…”

Section: Methodsmentioning

confidence: 99%

“…Surgery has been shown to be an effective treatment of endometriosis, with a recent doubleblind trial showing that both ablation and excision of superficial lesions provide equal relief of pain symptoms at 6 months in 65% of women [1]. A cohort study of 135 women has also revealed positive effects of surgery, with the majority of women reporting improvements in pain symptoms irrespective of stage or site of disease when followed up 2-5 years later [2].…”

Section: Introductionmentioning

confidence: 99%

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Deep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment of chronic pelvic pain

et al. 2006

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A cohort of 108 women with chronic pelvic pain underwent a laparoscopy, and a diagnosis of endometriosis was made in 88 (81%). Pre-operative and 2 years postoperative pain scores, using a ranked ordinal scale, were calculated for 44 women with complete pelvic organs (50%) and full data sets. Endometriosis was diagnosed on the basis of histological confirmation of the presence of glands and stroma in excised specimens and endometriosis classified by the American Society of Reproductive Medicine r-ASRM or by the presence of superficial or deep disease. The r-ASRM was a poor predictor of pain relief following surgery, and women with superficial disease did not respond well (in terms of appreciable, reduced pain) to surgical treatment, but good pain relief was seen with some women with nodular or infiltrating ('deep') disease. Women were also asked to complete a General Health Questionnaire. This showed an appreciable degree of depressive morbidity, which improved over the time of the study. Severity of initial global pain scores did not equate to the severity of endometriosis as categorised by either the r-ASRM score or the type of disease. This small study suggests that surgical therapy does not reduce pain scores in superficial endometriosis but is valuable in the treatment of deep or infiltrating disease. Longer-term follow-up of a larger cohort is necessary to evaluate further the value of surgery in this disease and to be further able to develop more accurate predictions of the outcome of surgical intervention in terms of pain relief.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment of chronic pelvic pain

et al. 2006

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“…Thus with the present symptom of pain, the lack of the surgeon's visual appreciation of endometriosis does not support a statement of disease eradication. The investigators also promote excision for stage I or II disease, whereas other reports have shown no difference of excision versus destruction of disease (4,5).…”

Section: To the Editormentioning

confidence: 99%

Does complete laparoscopic excision of endometriosis in teenagers really occur?

Laufer

Missmer

2011

Fertility and Sterility

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Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial

Keckstein

Brunecker

et al. 2022

Arch Gynecol Obstet

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Purpose Endometriosis is a benign, but potentially serious gynaecological condition in terms of abdominal pain and impaired fertility. Laparoscopic excision techniques are considered the therapeutic standard. HybridAPC is presented as a novel technique for the non-contact thermal ablation of peritoneal endometriosis with simultaneous protection of the underlying thermosensitive structures by creating a needle-free elevated fluid cushion which enables a safer exposure and distance, as well as potentially improved peritoneal conditioning prior to APC. Methods In this prospective randomized clinical trial, 39 patients with 132 superficial endometriotic lesions in total were treated with HybridAPC or sharp excision in an initial laparoscopic procedure according to randomization. In a second-look laparoscopy, adhesion formation was rated macroscopically. Histologic samples were taken from previously treated areas for evaluation of eradication rate. Results The eradication rate was not significantly different between HybridAPC treatment and sharp excision (65 vs. 81%, p = .55). Adhesions formed in 5% of HybridAPC-treated lesions and in 10% after sharp excision (p = .49). HybridAPC treatment was significantly faster than sharp excision (69 vs. 106 s, p < .05). No intra- and postoperative complications were registered. Conclusion This clinical trial demonstrates the feasibility of this novel surgical technique with a promising impact on adhesion prevention. Compared to sharp excision, HybridAPC is likely to be a safe, tissue-preserving, and fast method for the treatment of peritoneal endometriosis.

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A randomized trial of excision versus ablation for mild endometriosis

Cited by 17 publications

References 0 publications

Deep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment of chronic pelvic pain

Deep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment of chronic pelvic pain

Does complete laparoscopic excision of endometriosis in teenagers really occur?

Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial

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