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#Grand Rounds

Ablation or Excision for Endometriosis Associated Pain?

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BACKGROUND AND PURPOSE:

  • Evidence is inconclusive whether surgical excision or ablation is the superior approach for women with minimal to mild endometriosis undergoing laparoscopy
  • Riley et al. (JMIG, 2018) compared surgical excision versus ablation for treatment of endometriosis-associated chronic pelvic pain

METHODS:

  • Randomized clinical trial (RCT)
    • Minimal to mild endometriosis undergoing robot-assisted laparoscopy
    • 12-month follow up
  • Randomization arms
    • Excision
    • Ablation
  • Primary outcome
    • Visual analog scale (VAS) scoring at baseline and 6 and 12 months for
      • Menstrual pain | Nonmenstrual pain | Dyspareunia | Dyschezia
  • Secondary outcomes included surveys
    • Survey results at baseline and 6 and 12 months
      • Short Form Health Survey (SF-12) | Pelvic Organ Prolapse/ Urinary Incontinence Sexual Function Questionnaire (PISQ-qw) | International Pelvic Pain Assessment

RESULTS:

  • 37 received excision | 36 received ablation

Following ablation (vs before)

  • Dyspareunia (VAS scores)
    • 6 months mean change (MC): −14.07 (95% confidence interval [CI], −25.93 to −2.21; p = .02)
    • At 12 months: no significant difference
  • Dysmenorrhea
    • 6 months MC: −26.99 (95% CI, −41.48 to −12.50; p < .001)
    • 12 months MC: −24.15 (95% CI, 39.62 to −8.68; p = .003)

Following excision (vs before)

  • No significant changes were seen in VAS scores at 6 or 12 months

Comparing ablation to excision

  • Dyspareunia at 6 months MC: −22.96 (95% CI, −39.06 to −6.86; p = .01)
  • There were no other significant differences identified when assessing primary outcomes

Secondary outcomes

  • SF-12 physical component: Statistically significant improvement at 6 and 12 months for ablation and 6 months for excision
  • When comparing ablation to excision, only SF-12 physical component was statistically significant at 12 months

CONCLUSION:

  • Ablation of endometriosis lead to improvement in dysmenorrhea and dyspareunia
  • Only dyspareunia was significantly improved in ablation vs excision
  • The authors state

Excision and ablation are equivalent in the hands of a surgeon who does a complete surgical evaluation and treatment of endometriosis

Learn More – Primary Sources:

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

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Related ObG Topics:

Evaluation and Treatment of Endometriosis
Comparing IUD vs Implant for the Management of Endometriosis
Results from the LAROSE Study: Robotic Surgery vs Laparoscopy for Endometriosis

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