Correlation Between Surgical Phenotype and Pain Improvement After Endometriosis Surgery

Study Objective: To examine pain improvement after endometriosis surgery and whether it can be predicted by the observed surgical phenotype. Design: Prospective longitudinal survey study. Setting: A University hospital. Patients: A total of 125 patients completed a preoperative questionnaire (response rate: n = 227 of 277, 81.9%), had surgically confirmed endometriosis (n = 202 of 227), and returned a second postoperative questionnaire (response rate: n = 125 of 202, 61.9%). Interventions: All patients underwent complete laparoscopic removal of the endometriotic lesions. Surgical phenotype was classified according to the rASRM and #Enzian classification. Measurements and Main Results: The intensity of 5 specific pain symptoms was questioned by postal paper-pencil questionnaires with a numerical rating scale (0 - 10) both preoperatively (3.01 +/- 2.72 months before surgery) and one year after surgery (12.62 +/- 1.59 months). A postoperative pain improvement score was computed (postoperative pain - preoperative pain) for each specific pain symptom (0 - 10) and for the overall/global pain sum score (0 - 50). The mean intensity of all pain scores was lower postoperatively as compared with preoperatively (p < .0001). A statistically significant weak correlation was observed between the surgical phenotype "rectovaginal endometriosis" and postoperative improvement of dyspareunia (r = .265; p = .003). The other 11 hypothesized correlations between surgical phenotype and postoperative improvement of pain intensity failed to reach statistical significance. Conclusion: Clinicians can inform patients that surgery is effective in reducing endometriosis-related pain symptoms and the overall/global pain scores at 12 months postoperatively. From our data, we can conclude that patients with rectovaginal endometriosis might benefit the most from the reduction of their sexual pain. On the basis of these results, we could suggest that deep dyspareunia (even if present as an isolated symptom) might be a valid indication for surgery. Further research could explore the association between a certain surgical phenotype and more detailed assessments of sexual functioning, as well as explore whether feedback from the surgeon on expected pain improvement affects patient -reported outcomes.