Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation

Objective: To compare reduction of pain following laparoscopy after ablation or excision of endometriosis. Design: A prospective, randomized, double-blind study. Setting: Endometriosis and pelvic pain clinic at a university teaching hospital. Patient(s): Women of reproductive age presenting with pelvic pain and visually proved endometriosis. Intervention(s): Subjects completed a questionnaire rating their various pains using visual analogue scales (VASs). After visual identification subjects were assigned randomly to treatment with ablation or excision by supervised training gynecologists as primary surgeon. Follow-up questionnaires at 3, 6, 9, and 12 months documented pain levels. Main Outcome Measure(s): Change in overall pain VAS score at 12 months after operation. Result(s): There was no significant difference in reduction in overall pain VAS scores at 12 months when comparing ablation and excision. Conclusion(s): This study has not been able to demonstrate a significant difference in pain reduction between ablation and excisional treatments. Nonsignificant trends suggest that a larger study may find a difference in outcomes looking at dyspareunia or dyschezia. (Fertil Steril (R) 2010;94:2536-40. (C) 2010 by American Society for Reproductive Medicine.)