A randomized trial of excision versus ablation for mild endometriosis

Objective: To compare excisional and ablative treatment modalities for mild (revised American Fertility score 1-2) endometriosis in the management of chronic pelvic pain. Design: A randomized study of excision or ablation for mild endometriosis, participants and investigators alike blinded to the treatment modality at the follow-up visit. Setting: District general hospital with a specialist pelvic pain clinic in the United Kingdom. Patient(s): Women presenting with chronic pelvic pain. Intervention (s): Participants were asked to complete a questionnaire detailing symptoms related to chronic pelvic pain and rating their pain on a ranked ordinal scale. Areas of pelvic tenderness were identified and similarly ranked. At laparoscopy they were randomly assigned to excision or ablation of any endometriotic lesions, and the questionnaire was repeated at 6 months. Main Outcome Measure(s): Changes in pain score on a ranked ordinal scale after surgical treatment for mild endometriosis. Result(s): Both treatment modalities produced good symptomatic relief and reduction of pelvic tenderness (67%). There was no difference in morbidity; one woman in each group became pregnant during the study period. Only two participants reported no relief or a worsening of symptoms or signs. Conclusion(s): This small study showed good symptom relief at 6 months from pelvic pain for the majority of participants irrespective of the treatment modality, but two participants did not improve or got worse. A high pain score before treatment was a predictor of appreciable improvement. Further work is needed to identify women in whom surgical intervention is likely to produce a good response. (c) 2005 by American Society for Reproductive Medicine.