Surgery vs. hormone-based treatment for pain control in deep infiltrating endometriosis: a retrospective cohort study

Rezende, Gabriela Pravatta; Venturini, Marina Capovilla; Kawagoe, Lucas Nobushy; Yela, Daniela Angerame; Benetti‐Pinto, Cristina Laguna

doi:10.1080/03007995.2022.2031940

Cited by 2 publications

(2 citation statements)

References 48 publications

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“…It has been shown that patients visit a doctor's office an average of 10 times before receiving the diagnosis [14]. Endometriosis can be efficiently treated with both pharmacological and surgical approaches [15,16]. The advancement and widespread use of laparoscopic technology is pushing the boundaries of endometriosis surgery, and it is currently suggested to prefer laparoscopy to open surgery for endometrioma surgery [17].…”

Section: Discussionmentioning

confidence: 99%

“…Both medical and surgical treatment for pain in early-stage endometriosis has been shown to be equally beneficial in studies. Surgical treatment, on the other hand, has been demonstrated to be superior to medical treatment in the treatment and recurrence of chronic pelvic pain, dyschezia, and dyspareunia in cases of deep endometriosis [16]. Despite the fact that removal of endometriomas larger than 3 cm is suggested, some studies indicate that laparoscopic ablative surgery is an effective method for reducing pelvic pain in patients with Stage III-IV endometriosis with endometriomas [9,17].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

Göklü¹,

Göklü²,

İleri

et al. 2022

Aegean J Obstet Gynecol

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Abstract Introduction: Endometriosis is an estrogen-dependent, progressive inflammatory disease caused by the growth of endometrium-like tissue outside the uterine cavity. In women of reproductive age, it is a prevalent cause of pelvic pain. Surgical intervention may be required in the insufficiency of conservative treatments and laparoscopic procedures should be prioritized for surgery. The objective of our study was to compare the efficacy of laparoscopic fenestration-cauterization and cyst excision in patients with ovarian endometrioma on dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia symptoms. Materials and methods: The study comprised 112 patients with endometrioma who underwent laparoscopic surgery and whose data could be obtained. In 76.8% (n=86) of the patients, laparoscopic cystectomy was conducted, and in 23.2% (n=26) of the patients, laparoscopic fenestration+cauterization were performed. The patients' preoperative examination findings and VAS (Visual Analog Scale) pain levels were retrieved retrospectively. Patients were contacted again during the study, VAS pain scores were recalculated, and a gynecological ultrasound scan was performed to check for recurrence. The collected data were analyzed comparatively. Results: The mean age of the patients was 35.5 ± 6.8 years in the fenestration-cauterization group and 32.3 ± 5.9 years in the cystectomy group. 12.5% (n=14) of the cases were classified as stage I, 3.5% (n=4) as stage II, 32% (n=36) as stage III, and 52% (n=58) as stage IV. The operative time was significantly shorter in the fenestration+cauterization group compared to the cystectomy group (respectively/min 50.0±18.4 /61.3.±16.8, p=0.014). In both groups, the number of patients with dysmenorrhea, NMPP, dyspareunia, and dyschezia who had high VAS pain scores decreased significantly (p<0.005). In both procedures, there was no difference between recurrence rates (p=0.801). After surgical treatment, there was a significant decrease in the number of stage III-IV patients with dysmenorrhea and NMPP who had high VAS (p<0.005). Conclusion: We emphasize the significance of laparoscopy in the surgical treatment of endometriosis. Both laparoscopic fenestration + cauterization and laparoscopic cystectomy significantly reduced pain symptoms, especially in patients with advanced endometriosis. The efficacy and recurrence rates of both treatments were not significantly different. Keywords: Endometriosis, endometrioma, pelvic pain, laparoscopic surgery, recurrence

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

Göklü¹,

Göklü²,

İleri

et al. 2022

Aegean J Obstet Gynecol

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In the thicket of fears, doubts, and murky facts: some reflections on treatment modalities for endometriosis-associated pain

Canis

Guo

2023

Human Reproduction

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Endometriosis-associated pain can be managed by either surgery or hormonal therapy. The final decision as to which treatment modality to take is based on efficacy and possible complications of different treatment modalities, risk of recurrence, and the patient’s wishes and preferences. But in the thicket of fears, doubts, and murky facts, the choice may ultimately be the trade-off between irrational fears and ignorance versus scientific evidence. We elaborate some pros and cons of the two treatment modalities and highlight some notable downsides of hormonal therapy, in particular the possible yet unquantified risk of long-term hormonal therapy for malignant transformation, perhaps with the only exception of combined oral contraceptives. Thus, when discussing with patients, we advocate the approach of discussing the advantages and disadvantages of all treatment options in detail, accounting for the known pros and cons with a full understanding of the predictive irrationality of human beings. For endometriosis-associated pain, surgery is definitely not a failure of medicine but, rather, a viable option, especially given the recently surfaced undercurrent of wariness and dissatisfaction with the current hormonal drugs among patients with endometriosis. Above all, there is a pressing need to fill the knowledge gap of perioperative interventions intended to reduce the risk of recurrence and to fulfill the demand for the development of safe and efficacious non-hormonal therapeutics.

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Surgery vs. hormone-based treatment for pain control in deep infiltrating endometriosis: a retrospective cohort study

Cited by 2 publications

References 48 publications

Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

In the thicket of fears, doubts, and murky facts: some reflections on treatment modalities for endometriosis-associated pain

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