European Journal of Obstetrics & Gynecology and Reproductive Biology
Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain
Introduction
The existence of a relationship between pain and endometriosis is widely accepted by gynaecologists [1], [2]. Laparoscopic excision of endometriosis results in pain relief, improved reproductive outcomes, and increased quality of life. Unfortunately, even with surgeons experienced in laparoscopy, 6–51% of women will have a recurrence of endometriosis within 5 years of surgery [3], [4].
Few studies have analysed the determinants of recurrence rate in endometriosis, and the available data are controversial. The inconsistencies found in literature may be due to the complexity of endometriosis itself or to widespread methodological problems in the current studies: (i) limited and/or heterogeneous samples, (ii) few studies conducted with a second-look surgery, (iii) failure to control for endometriosis stage and symptomatology, as well as (iv) use of improper statistical analyses. Although some authors have considered recurrence of pain (dysmenorrhoea, dyspareunia or chronic pelvic pain) [3], [5] ultrasound findings [3], [5], [6], [7] or increased CA125 levels [3], [5] to be the definition of endometriosis recurrence, there is still absence of a standardised definition.
The aim of this study was to analyse the effectiveness of laparoscopic treatment of endometriosis and to assess prognostic factors that might influence the recurrence rate for pain and endometriosis.
In a further analysis, we hypothesised that patients with recurrence/occurrence of pelvic pain may be at increased risk for the recurrence of endometriosis and sought to investigate this relationship.
Section snippets
Materials and methods
We reviewed the medical records of 593 consecutive patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 in the Department of Gynaecology, Perinatology and Human Reproduction at the University of Florence, Italy. Inclusion criteria were: first conservative laparoscopy for endometriosis, diagnosis of endometriosis histologically confirmed, Transvaginal-ultrasound (TV-US) follow-up after laparoscopy. Following these criteria, 401 women were included in our
Results
Among 593 consecutive patients submitted to laparoscopy for endometriosis, 401 (67.6%) underwent periodic TV-US after surgery (114 with stage I or II endometriosis; 287 with stage III or IV endometriosis). The mean duration of observation per patient was 6.2 ± 4.1 years (median time 6 years, range 2–11 years). Table 1 shows the general features of the sample that received TV-US after surgery (Table 1).
Comments
Our study confirms the effectiveness of treating endometriosis with laparoscopic excision in order to reduce patients’ pain, a finding also reported by others [14], [15], [16], [17]. Of 278 women suffering from painful symptoms before surgery, 140 (50.3%) did not experience such symptoms after laparoscopic treatment. Of the 216 infertile women in our sample, 117 (54.2%) were able to achieve pregnancy after surgery.
A younger age at menarche and dysmenorrhoea severity demonstrated risk factors
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