Pain and quality of life following laparoscopic excision of endometriosis.

STUDY OBJECTIVES: To evaluate the long-term impact of laparoscopic excision of endometriosis on quality of life, through pain reduction, as measured by the Endometriosis Health Profile-30 (EHP-30), in uterine-sparing (preservation of the uterus and at least one ovary) and non-uterine sparing (removal of the uterus) surgery.

DESIGN: Cohort study.

SETTING: Academic medical center.

PATIENTS: 61 women who had undergone laparoscopic excision of endometriosis for pelvic pain and were enrolled in a tissue procurement study.

INTERVENTIONS: Patients who had previously completed an EHP-30 preoperatively and at 4-weeks postoperatively were mailed a copy of the EHP-30 2.6-6.8 years after their index surgery.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was quality of life as measured by changes in the EHP-30 prior to their index surgery compared to weeks and years later. Secondary outcome was a comparison of the EHP-30 between patients who underwent excision of endometriosis alone versus excision of endometriosis with hysterectomy +/- oophorectomy. From 2011 to 2015, 61 women underwent laparoscopic excision of endometriosis for pelvic pain. 46 of 61 patients completed the EHP-30 for a response rate of 75%. Patients demonstrated significant improvement in all 5 scales of the EHP-30 (pain, control and powerlessness, emotions, social support and self-image) at 4-weeks postoperative (p<0.001) which persisted for up to 6.8 years in follow-up (p<0.001) when compared to their baseline scores. Improvement in EHP-30 scores did not differ by ASRM staging or index surgery. Definitive surgery (TLH/BSO) was not associated with improved outcomes when compared with uterine-sparing surgery.

CONCLUSIONS: Laparoscopic excision of endometriosis offers improvement in all quality of life domains as measured by the EHP-30, including a reduction in pain, an effect that may persist for up to 6.8 years. These findings suggest that laparoscopic excision of endometriosis with uterine preservation can be considered as an option to discuss during counseling for treatment of endometriosis.