#Grand Rounds

Ablation or Excision for Endometriosis Associated Pain?

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

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

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)

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

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

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