The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up

Background: This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis. Methods: In this prospective observational cohort study, 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis. Of these, 216 women underwent surgical assessment and 176 were confirmed to have endometriosis. Questionnaires and visual analogue scale (VAS) scores for dysmenorrhoea, non-menstrual pelvic pain, dyspareunia and dyschesia as well as quality of life instruments; the EQ-5Dindex and EQ-5Dvas, Short-Form 12 (SF-12) and sexual activity questionnaires were completed pre-operatively. Intra-operative details of revised American Fertility Society (rAFS) stage, site of disease, associated tests, duration of surgery and complications were noted. Follow-up was performed by postal questionnaire and chart review. For women who had further surgery, rAFS stage, site of disease, other procedures and histology were all recorded. Results: Pain scores were all significantly reduced at 2-5 years for dysmenorrhoea (median VAS baseline versus follow-up 2-5 years); 9 versus 3.3 (P<0.0001), non-menstrual pelvic pain 8 versus 3 (P<0.0001), dyspareunia 7 versus 0 (P<0.0001) and dyschesia 7 versus 2 (P<0.0001). Quality of life was improved for the EQ-5Dindex (P=0.008 and the EQ-5Qvas (P=0.03) and for sexual function with pleasure (P=0.001) and habit (P=0.012) being improved and discomfort being decreased (P=0.001). The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36%. A rAFS score of >70 was predictive of requiring further surgery (P=0.03). Of women who had further surgery, endometriosis was found histologically in 68%. Conclusions: Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years. The probability of requiring further surgery is 36%. Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence.