Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 laser ablation

Abstract

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.

Endometriosis: Epidemiology, Diagnosis and Clinical Management

“…Surgical techniques include excision or removal of endometrial implants, ablation of uterosacral nerves by employment of endocoagulation, electrocautery or laser treatment, presacral neurectomy, and hysterectomy with bilateral salpingooophorectomy [95, 96]. They have 50–80% success rate in reducing symptoms.…”

Endometriosis: where are we and where are we going?

“…Several different surgical techniques are performed (Table 2), including excision/removal of endometriosis, uterosacral nerve ablation, presacral neurectomy, and hysterectomy with bilateral salpingo-oophorectomy (BSO) (Daniels et al 2010, Healey et al 2014, Posadzka et al 2015), and some techniques provide better symptomatic control than others. For symptom improvement and preventing disease recurrence, endometrioma removal is superior to drainage (Duffy et al 2014, Practice Committee of the American Society for Reproductive 2014).…”

Effect of an Educational Intervention on Quality of Life and Sexual Function in Women with Endometriosis

“…Part (4): Numerical rating scale was adopted from Posadzka et al (2015) to assess the intensity of endometriosis-related pain symptoms as dysmenorrhea, dyspareunia, and non-menstrual pelvic pain…etc. Women asked to rate the current intensity of endometriosis-related pain symptoms where, (0) indicating no pain and (10) indicating the worst possible pain.…”