Retroperitoneal endometriosis and pelvic pain: Results of laparoscopic uterosacral ligament resection according to the rAFS classification and histopathologic results

The objective of this work was to assess the efficacy of laparoscopic surgical resection of the uterosacral ligament(s) (USL) in patients with pelvic pain associated with suspected infiltration of these ligaments by retroperitoneal endometriosis. We analyzed a continuous series of 85 patients treated by operative laparoscopy between November 1, 1992, and April 30, 1996. In all cases, treatment consisted of resection of all the uterosacral ligament(s) together with eradication of all other endometriotic lesions. The results were assessed for all the patients with a minimum follow-up of 3 months (69 patients, 81.2%). For the 50 patients with severe dysmenorrhea, improvement was observed in 92% of cases (46 patients). When improvement was noted, it was considered excellent or satisfactory in 82.6% of cases (38/46). For the 51 patients with severe deep dyspareunia, improvement was observed in 92.2% of cases (47 patients). When improvement was observed, it was excellent or satisfactory in 87.2% of cases (41/47). For patients with dysmenorrhea, the rate of improvement was significantly greater for patients with stage 3 or 4 endometriosis than for those with stage 1 or 2 disease: 94.7% (18 patients) versus 64.5% (20 patients); p = 0.01. For patients suffering from dyspareunia, the results did not differ significantly according to whether they had stage 1, 2 endometriosis, or stage 3, 4 endometriosis: 76.5% (26 patients) versus 16 patients (88.2%); p = ns. The efficacy of the laparoscopic surgical treatment did not differ significantly according to whether the histologic results were positive or negative, whether for dysmenorrhea (81.6% [31 patients] versus 58.3% [7 patients]; p = ns) or for deep dyspareunia (82.3% [28 patients] versus 76.5% [13 patients]; p = ns). These results demonstrated that if the surgeon is highly skilled in laparoscopy, operative laparoscopy is effective for the treatment of patients with painful symptoms related to deep endometriotic implants on the uterosacral ligaments.