Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial

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Abstract

Study Objective: To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain. Design: Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I). Setting: Single academic tertiary care hospital. Patients: Women with minimal to mild endometriosis undergoing laparoscopy. Interventions: Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy. Measurements and Main Results: Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n = 37) or ablation (n = 36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], −14.07; 95% confidence interval [CI], −25.93 to −2.21; p =.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, −26.99; 95% CI, −41.48 to −12.50; p <.001) and 12 months (MC, −24.15; 95% CI, 39.62 to −8.68; p =.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, −22.96; 95% CI, −39.06 to −6.86; p =.01). Conclusion: Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis.

Original languageEnglish (US)
Pages (from-to)71-77
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2019

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Endometriosis
Dyspareunia
Randomized Controlled Trials
Pain
Dysmenorrhea
Visual Analog Scale
Confidence Intervals
Pelvic Pain
Laparoscopy
Pelvic Organ Prolapse
Urinary Incontinence
Advisory Committees
Pain Measurement
Tertiary Healthcare
Constipation
Health Surveys
Tertiary Care Centers
Chronic Pain
Counseling
Therapeutics

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

@article{088a33f705734520babc6018b7ce4628,
title = "Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial",
abstract = "Study Objective: To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain. Design: Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I). Setting: Single academic tertiary care hospital. Patients: Women with minimal to mild endometriosis undergoing laparoscopy. Interventions: Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy. Measurements and Main Results: Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n = 37) or ablation (n = 36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], −14.07; 95{\%} confidence interval [CI], −25.93 to −2.21; p =.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, −26.99; 95{\%} CI, −41.48 to −12.50; p <.001) and 12 months (MC, −24.15; 95{\%} CI, 39.62 to −8.68; p =.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, −22.96; 95{\%} CI, −39.06 to −6.86; p =.01). Conclusion: Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis.",
author = "Riley, {Kristin A.} and Andrea Benton and Timothy Deimling and Allen Kunselman and Gerald Harkins",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jmig.2018.03.023",
language = "English (US)",
volume = "26",
pages = "71--77",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
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}

TY - JOUR

T1 - Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain

T2 - A Randomized Controlled Trial

AU - Riley, Kristin A.

AU - Benton, Andrea

AU - Deimling, Timothy

AU - Kunselman, Allen

AU - Harkins, Gerald

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study Objective: To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain. Design: Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I). Setting: Single academic tertiary care hospital. Patients: Women with minimal to mild endometriosis undergoing laparoscopy. Interventions: Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy. Measurements and Main Results: Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n = 37) or ablation (n = 36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], −14.07; 95% confidence interval [CI], −25.93 to −2.21; p =.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, −26.99; 95% CI, −41.48 to −12.50; p <.001) and 12 months (MC, −24.15; 95% CI, 39.62 to −8.68; p =.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, −22.96; 95% CI, −39.06 to −6.86; p =.01). Conclusion: Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis.

AB - Study Objective: To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain. Design: Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I). Setting: Single academic tertiary care hospital. Patients: Women with minimal to mild endometriosis undergoing laparoscopy. Interventions: Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy. Measurements and Main Results: Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n = 37) or ablation (n = 36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], −14.07; 95% confidence interval [CI], −25.93 to −2.21; p =.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, −26.99; 95% CI, −41.48 to −12.50; p <.001) and 12 months (MC, −24.15; 95% CI, 39.62 to −8.68; p =.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, −22.96; 95% CI, −39.06 to −6.86; p =.01). Conclusion: Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis.

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