Laparoscopic surgery for pelvic pain associated with endometriosis

Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity. It is variable in both its surgical appearance and clinical manifestation often with poor correlation between the two. Surgical treatment of endometriosis aims to remove visible areas of endometriosis and restore anatomy by division of adhesions. The objectives were to assess the efficacy of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis. The review aims to compare the effectiveness of any laparoscopic procedure versus any other treatment modality including expectant management. The search strategy of the Menstrual Disorders and Sub-fertility Review Group was used to identify all publications that described or might have described randomised trials of laparoscopic surgery in the treatment of symptomatic endometriosis. For a full description of the Review Group strategy see the Review Group details. Trials were selected if they were randomised and compared the effectiveness of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis with other treatment modalities or placebo. One study had data appropriate for inclusion within the review. This study compared laparoscopic laser surgery with diagnostic laparoscopy. Pain relief was the primary outcome measure. The data was extracted independently by two reviewers. In comparison to expectant treatment there is a significant degree of pain relief at six months after surgery with laser laparoscopic surgery for minimal mild and moderate endometriosis. Odds Ratio (OR) 4.97 95% Confidence Interval (CI) 1.8513.39 The combined surgical approach of laparoscopic laser ablation adhesiolysis and uterine nerve ablation is likely to be a beneficial treatment for pelvic pain associated with minimal mild and moderate endometriosis. As only one trial is included in the analysis this conclusion should be interpreted with caution. (authors)