Long-term Follow-up after Complete Treatment ofPeritoneal Endometriosis with a CO2 Laser

Overview

Objective:
To evaluate the effect of laparoscopic C02 laser ablation of peritoneal endometriosis inthe treatment of pelvic pain with a long-term follow-up. To differentiate the effect of surgery ondifferent types of pelvic pain.Design: Prospective observational study.Setting: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University andGeneral Faculty Hospital, Prague.Methods: Patients with lst to 3rd stage endometriosis, with manifestation of pelvic pain, and withcomplete excision of peritoneal endometriosis lesions, were included in the study. All visible lesionswere vaporized by CO2 laser following adhesiolysis and complete visualization of the pelvis. Afterthe procedure, patients were followed up at 6-month intervals. The severity of pelipathia, dyspareunia,dysmenorrhea, pain during micturition, and pain during defecation were monitored usinga visual analog score of 10 points.Results: A total of 31 patients were included in the study. After 6, 12, and 18 months after surgery,the recurrence of pelvic pain was found in 12 (39%), 15 (48%), and 19 (61%) patients, respectively.Improvement or disappearance of complaints was documented 18 months after the surgery in 11cases of dysmenorrhea (50%), 9 cases of dyspareunia (50%), 14 cases of pelipathia (58%), 12 cases ofpain during micturition (71%), and in 14 cases of pain during defecation (87.5%). The proportion ofrecurrences increases with the length of the interval after the procedure, mainly in dysmenorrheaand dyspareunia. Conclusions: The effect (improvement or disappearance of pelvic pain) of a complete CO2 laserablation of peritoneal endometriosis continues 18 months after the surgery in about 40% of patients.A graduated increase in the number of recurrences is apparent during follow-up, most significantlyin dysmenorrhea and dyspareunia. The effect of surgery on different types of pelvic pain varies.A small number of recurrences was found in pain during micturition and pain during defecation,on the other hand, less success was apparent in the treatment of dysmenorrhea.

Key words:
endometriosis, laser, pelvic pain, dysmenorrhea, dyspareunia, pelipathia