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

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