AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

The Pelvis in Pain
Endometriosis and Beyond
Free Communications Chairmen’s Choice - Friday 8 March
This study aims to compare the reduction of pain following
laparoscopy after ablation or excision of endometriosis. The
published analysis at 12 months follow-up did not show any
significant overall pain reduction between the two groups (2).
Here is a further analysis of the long term five year follow up
of these women.
METHODS: This study was a prospective randomized double
blind study conducted in the endometriosis and pelvic pain
clinic at Royal Women’s Hospital Melbourne. Recruitment
occurred from July 2001 to September 2007 and follow up
from July 2001 to September 2012. Subjects were women of
reproductive age presenting with pelvic pain and visually
proven endometriosis on laparoscopy that provided informed
consent, spoke English, over 18 years of age and were not
on hormonal therapy. Preoperatively, subjects completed
a questionnaire rating their various pain symptoms using
Visual Analogue Scales (VASs). Intra-operatively, subjects
were randomly assigned to excision or ablation surgical
treatment after American Fertility Society system scoring and
visual exclusion of obvious endometriosis involving muscle
levels of bowel, bladder or ureter. Follow up questionnaires at
3 monthly intervals in the first year and 6 monthly intervals
for the following 4 years documented pain levels. Analysis
of data was performed using SPSS version 11.5. The study
was approved by the Research and Ethics Committees of the
Royal Women’s Hospital, Melbourne.
RESULTS: A total of 335 subjects were recruited and
underwent laparoscopy. Of these, 178 subjects were assigned
randomly to ablation (N=89) and excision (N=89). Of the 157
subjects not randomized, 101 did not have endometriosis, 20
had endometriosis involving rectum, bladder or ureter muscle
and 36 had possible endometriosis confirmed on histology.
Median revised AFS scores (95% confidence interval) were 10
for the excision group and 7 for the ablation group. Response
rates for questionnaires at 6 months, 12 months and 5 years
post laparoscopy were 80%, 71% and 46% respectively.
There was a reduction in all pain scores over the five year
follow up in both treatment groups but there remained no
significant difference in reduction of overall pain between the
excision and the ablation groups. There was a trend towards
a higher reduction in sex pain in the excision group which
became significant at 3 years 6 months (p=0.015); 4 years 6
months (p=0.047) and at 5 years (p=0.031).
There was significantly more medical treatment used within
the ablation group over five years (p