Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery

Abstract

GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment. It seems that it has no role on post-surgical pain when the surgeon is able to completely excise DIE implants.

Comparison of Complete and Incomplete Excision of Deep Infiltrating Endometriosis

“…Our results showed that postoperative QOL was improved in both groups, which was also in agreement with the previous study [29,[32][33][34][35]. The QOL in incomplete surgery is comparable with the QOL in the complete surgery group in the physical, social, environmental and selfassessment aspect.…”

“…There was a greater improvement in psychological score in complete excision group than in in-complete excision group, which implicated that the reassurance of complete excision also had a psychological effect on the patients. In Angioni's study [35], at 1-year followup patients treated with complete resection showed significant improvement in physical function, general health, and vitality in comparison to 12 months follow-up of the patients who underwent an incomplete surgical treatment. This difference might due to that our patients were given GnRH agonist followed by contraceptive pills or merely contraceptive pills after surgery.…”

Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)

“…This operation has been conducted by operative laparoscopy as described elsewhere [41,42]. Moreover, clinicians use laparoscopic surgical resection in cases of deep endometriosis infiltrating the uterosacral ligaments [43][44][45][46][47]. In this case, it is necessary to conduct ureterolysis to be able to execute the uterosacral ligament (USL) nodule completely without any risk of ureter injury.…”

Traitement médical de l’endométriose : pas une simple option, mais une obligation !

“…Cette diminution était plus marquée au cours de premiers six mois, ensuite les valeurs des volumes restaient sensiblement stables [8], probablement en rapport avec la nature histologique des nodules d'endométriose profonde qui sont composés dans une proportion d'environ 75 % du tissu fibro-conjonctif et de cellules musculaires lisses indifférentes à l'action du traitement hormonal [12]. Dans une autre étude comparant l'évolution postopératoire des douleurs chez les patientes ayant bénéficié d'une chirurgie de l'endométriose profonde, les scores des douleurs enregistrés après une résection complète étaient comparables avec ceux observés après une résection incomplète associée à un traitement continu par des analogues de la GnRH [13].…”

“…La survenue des ces événements justifie dans notre opinion plutôt le remplacement du médicament incriminé par un autre de composition différente que l'arrêt complet du traitement médical, qui est généralement suivi par la reprise des douleurs au cours des six mois suivants [13].…”