Patient satisfaction and changes in pain scores after ablative laparoscopic surgery for stage III-IV endometriosis and endometriotic cysts

Objective: To document the changes in pain scores 3-12 months following ablative laparoscopic surgery. Secondary outcome measures included patient satisfaction scores. Design: A prospective, cohort study. Setting: A tertiary referral center for the treatment of endometriosis. Patient(s): Seventy-three consecutive women with stage III-IV endometriosis and an endometrioma >2 cm. Intervention(s): A laparoscopy was performed. The extraovarian endometriosis was ablated with a CO2 laser, and the endometrioma capsule was fenestrated then ablated with the potassium-titanic-phosphate (KTP) laser or the Bicap(TM) bipolar diathermy. Main Outcome Measure(s): Pre- and postoperative visual analogue scores for pelvic pain were completed. Patient satisfaction was scored from I to 10, with a score of 10 being most satisfied. Result(s): A total of 73 women with stage III-IV endometriosis and 96 cysts (23 cysts were bilateral). The mean revised American Fertility Society (AFS) score was 65.5 (range 22-128). At 12 months, the mean temporal decrease in the pain score for dyspareunia was 2.14 +/- 0.41; for dysmenorrhea, 1.52 +/- 0.38; and for chronic nonmenstrual pain, 2.37 +/- 0.43. Sixty-four (87.7%) patients were satisfied or very satisfied with the treatment. No surgical complications occurred. Conclusion(s): Laparoscopic ablative surgery for endometriomas in the presence of stage III-IV endometriosis is an effective treatment for relieving pelvic pain. (C) 2003 by American Society for Reproductive Medicine.