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

Abstract

Study ObjectiveTo compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain. DesignRandomized clinical trial with 12-month follow-up (Canadian Task Force classification I). SettingSingle academic tertiary care hospital. PatientsWomen with minimal to mild endometriosis undergoing laparoscopy. InterventionsExcision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy. Measurements and Main ResultsPrimary 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). ConclusionTreatment 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.