A Cochrane review [Abstract] 1 included 14 studies with a total of 1563 subjects. Laparoscopic surgery was more effective in treating pelvic pain associated with mild to severe endometriosis at six months post operatively compared to diagnostic laparoscopy only (OR 6.58, 95% Cl 3.31 to 13.10; 3 studies, n=171). There were uncertainty of the effect of laparoscopic ablation versus laparoscopic excision and helium thermal coagulator versus electrodiathermy on pain and quality of life.
A prospective, multicenter cohort study 2 assess the impact of surgical treatment on quality of life and pain over a 3-year period of postoperative follow-up in 981 women. The VAS for dysmenorrhea fell from 5.3 ± 3.7 (time 0) to 2.6 ± 3.3 at 6 months, and 2.3 ± 3.3 at 36 months of follow-up (p <.001). VAS for chronic pelvic pain and dyspareunia fell from 2.6 ± 3.5 and 2.7 ± 3.2, respectively, before surgery to 1.4 ± 2.5 and 1.1 ± 2.2 at 6 months and then 1.3 ± 2.5 and 1.2 ± 2.3 at 36 months of follow-up. The Short Form 36-Item survey analysis revealed the greatest increases linked to physical domains (i.e., bodily pain and role limitations) from 54.6 ± .9 and 63.3 ± 1.3, respectively, at time 0 to 74.4 ± .9 and 81.9 ± 1.1 at 6 months of follow-up (p <.001), with scores subsequently remaining stable.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals) but upgraded by large magnitude of effect.
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