Excisional Endometriosis Surgery with Hysterectomy and Bilateral Salpingo-oophorectomy Versus Excisional Endometriosis Surgery Alone for Pelvic Pain Associated with Deep Endometriosis

Overview

Journal Facts Views Vis Obgyn

Specialty Gynecology & Obstetrics

Date 2023 Apr 3

PMID 37010333

Authors

N Manobharath

J Lewin

M Hirsch

J Naftalin

A Vashisht

A Cutner

E Saridogan

Affiliations

Soon will be listed here.

Abstract

Background: There is no agreed consensus on the optimal surgical treatment for pain associated with endometriosis.

Objectives: To compare improvement in symptoms and quality-of-life in patients undergoing excisional endometriosis surgery (EES) versus EES with hysterectomy and bilateral salpingo-oophorectomy (EES-HBSO).

Methods: This study evaluated patients undergoing EES and EES-HBSO at a single endometriosis centre between 2009 and 2019. Data was obtained from the British Society for Gynaecological Endoscopy database. Adenomyosis was assessed by blinded re-analysis of imaging and/or histology data.

Main Outcome Measures: Pain scores (numeric rating scale 0-10) and quality-of-life scores (EQ-VAS) before and after EES and EES-HBSO.

Results: We included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis.

Conclusion: EES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.

References

Stewart K, Tessier K, Lebovic D . Comparing Characteristics of and Postoperative Morbidity after Hysterectomy for Endometriosis versus other Benign Indications: A NSQIP Study. J Minim Invasive Gynecol. 2022; 29(7):884-890.e2. PMC: 10084482. DOI: 10.1016/j.jmig.2022.04.009. View

Sullivan M, Adams H, Tripp D, Stanish W . Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression. Pain. 2007; 135(1-2):151-9. DOI: 10.1016/j.pain.2007.05.021. View

Surrey E, Soliman A, Yang H, Du E, Su B . Treatment Patterns, Complications, and Health Care Utilization Among Endometriosis Patients Undergoing a Laparoscopy or a Hysterectomy: A Retrospective Claims Analysis. Adv Ther. 2017; 34(11):2436-2451. PMC: 5702365. DOI: 10.1007/s12325-017-0619-3. View

Bougie O, McClintock C, Pudwell J, Brogly S, Velez M . Short-term outcomes of endometriosis surgery in Ontario: A population-based cohort study. Acta Obstet Gynecol Scand. 2020; 100(6):1140-1147. DOI: 10.1111/aogs.14071. View

Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J . Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017; 1:CD004143. PMC: 6465148. DOI: 10.1002/14651858.CD004143.pub5. View

Becker C, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L . ESHRE guideline: endometriosis. Hum Reprod Open. 2022; 2022(2):hoac009. PMC: 8951218. DOI: 10.1093/hropen/hoac009. View

Kurabayashi T, Yahata T, Honda A, Tomita M, Yasuda M, Tanaka T . Effect of long-term hormone replacement therapy on the bone in ovariectomized women with cancer. Int J Gynaecol Obstet. 1998; 60(3):271-7. DOI: 10.1016/s0020-7292(97)00272-5. View

Sandstrom A, Bixo M, Johansson M, Backstrom T, Turkmen S . Effect of hysterectomy on pain in women with endometriosis: a population-based registry study. BJOG. 2020; 127(13):1628-1635. DOI: 10.1111/1471-0528.16328. View

Soriano L, Lopez-Garcia E, Schulze-Rath R, Garcia Rodriguez L . Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from The Health Improvement Network and the Hospital Episode Statistics database. Eur J Contracept Reprod Health Care. 2017; 22(5):334-343. DOI: 10.1080/13625187.2017.1374362. View

10.

Fedele L, Bianchi S, Zanconato G, Berlanda N, Borruto F, Frontino G . Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol. 2005; 193(1):114-7. DOI: 10.1016/j.ajog.2004.12.085. View

11.

Dunselman G, Vermeulen N, Becker C, Calhaz-Jorge C, DHooghe T, De Bie B . ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014; 29(3):400-12. DOI: 10.1093/humrep/det457. View

12.

Namnoum A, Hickman T, Goodman S, Gehlbach D, Rock J . Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995; 64(5):898-902. DOI: 10.1016/s0015-0282(16)57899-6. View

13.

Vashisht A, Gulumser C, Pandis G, Saridogan E, Cutner A . Voiding dysfunction in women undergoing laparoscopic treatment for moderate to severe endometriosis. Fertil Steril. 2009; 92(6):2113-5. DOI: 10.1016/j.fertnstert.2009.06.012. View

14.

Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A . Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol. 2010; 17(5):600-4. DOI: 10.1016/j.jmig.2010.05.008. View

15.

Kondo W, Bourdel N, Tamburro S, Cavoli D, Jardon K, Rabischong B . Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2010; 118(3):292-8. DOI: 10.1111/j.1471-0528.2010.02774.x. View

16.

Li Y, de Vries B, Cooper M, Krishnan S . Bowel and bladder function after resection of deeply infiltrating endometriosis. Aust N Z J Obstet Gynaecol. 2014; 54(3):218-24. DOI: 10.1111/ajo.12199. View

17.

Ceccaroni M, Bounous V, Clarizia R, Mautone D, Mabrouk M . Recurrent endometriosis: a battle against an unknown enemy. Eur J Contracept Reprod Health Care. 2019; 24(6):464-474. DOI: 10.1080/13625187.2019.1662391. View

18.

Byrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark T . Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open. 2018; 8(4):e018924. PMC: 5892761. DOI: 10.1136/bmjopen-2017-018924. View

19.

Faubion S, Kuhle C, Shuster L, Rocca W . Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015; 18(4):483-91. PMC: 4581591. DOI: 10.3109/13697137.2015.1020484. View

20.

Matorras R, Elorriaga M, Pijoan J, Ramon O, Rodriguez-Escudero F . Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy. Fertil Steril. 2002; 77(2):303-8. DOI: 10.1016/s0015-0282(01)02981-8. View