Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis

Sutton, Christopher; Ewen, Simon P.; Whitelaw, Naomi L.; Haines, Patricia

doi:10.1016/s0015-0282(16)56990-8

Cited by 454 publications

(51 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 Most studies on the surgical management of endometriosis use pelvic pain as the primary outcome as measured by VAS scores. 1,3,5 A potential problem with using pelvic pain as the primary outcome of a study on endometriosis is that some components of pain may improve after surgically treating endometriosis whereas others may not, at least to the same extent. A QOL assessment may be a better overall measure of the clinical benefit of surgery for treating endometriosis by translating multiple pain symptoms to a single measure of their effect on daily functioning.…”

Section: Discussionmentioning

confidence: 99%

“…There is little evidence from randomized controlled trials (RCTs) to guide surgical management of endometriosis-associated pelvic pain. In the classic RCT by Sutton et al 1 published in 1994, the combination of laparoscopic ablation and laser uterosacral nerve ablation was compared with no surgical treatment. There was a statistically significant improvement in the treatment group compared with no treatment at 6 months (62.5% vs 22.6%), and this benefit was continued in more than 90% of patients for up to 1 year.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Pilot Feasibility Multicenter Study of Patients After Excision of Endometriosis

Yeung

Bajzak

et al. 2013

JSLS

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Pilot Feasibility Multicenter Study of Patients After Excision of Endometriosis

Yeung

Bajzak

et al. 2013

JSLS

View full text Add to dashboard Cite

show abstract

“…However, some clinical studies provide evidence that pain symptoms are reduced after surgical excision of the pEL [31,32], but still less than half of the treated women responded to the pain-reducing surgery [33,34]. However, other studies could not verify this level of chronic pelvic pain reduction after peritoneal lesion excision in endometriosis patients [35,36].…”

Section: Discussionmentioning

confidence: 99%

Neuroimmunomodulatory Alterations in Non-Lesional Peritoneum Close to Peritoneal Endometriosis

Arnold¹,

Vercellino²,

Chiàntera³

et al. 2012

Neuroimmunomodulation

View full text Add to dashboard Cite

Objectives: An imbalance in the ratio of sensory to sympathetic nerve fibre (NF) density in peritoneal endometriotic lesions (pEL) has recently been demonstrated and leads to the assumption that this preponderance of the sensory pro-inflammatory milieu is a major cause of pain in endometriosis. Therefore, the density of sensory and sympathetic NFs was determined in distal unaffected peritoneum of endometriosis patients to be able to detect possible alterations in unaffected peritoneum. Methods: In serial pEL sections (n = 40), lesional and matching unaffected peritoneum as well as healthy peritoneum (HP) from patients without endometriosis (n = 15) were immunohistochemically analysed to identify protein gene product 9.5-, substance P- and tyrosine hydroxylase-positive NFs (intact, sensory and sympathetic NFs, respectively). In addition, the amount of immune cell infiltrates and the expression of nerve growth factor (NGF) and interleukin (IL)-1β in nerves of peritoneal endometriotic specimens were compared to those in the HP. Results: The overall NF density in the non-lesional, unaffected peritoneum of endometriosis patients is significantly reduced in comparison to both HP and pEL, while sensory NFs remain the same; the sympathetic NF density is significantly decreased compared to HP, but is still higher than the density close to the pEL. Immune cell infiltrates as well as NGF and IL-1β expression in nerves is significantly elevated in distal unaffected peritoneum in comparison to HP. Conclusion: The altered NF density in the non-lesional, unaffected peritoneum of endometriosis patients suggests new aspects in the understanding of the development of endometriosis and pain management in endometriosis.

show abstract

“…These include drugs that suppress ovarian function (which can have adverse effects [5]) or surgery for the lesions (usually laparoscopically). Surgical removal is often considered the best option for symptomatic endometriosis [6], but it does not reduce pain in 20%-28% of patients who undergo surgery [7,8].…”

Section: Background On Endometriosismentioning

confidence: 99%

“…Quantifying the potential for improvement in a woman's symptoms after surgery is important for guiding clinical decisions and treatment strategies. Secondary findings from observational, single-center studies indicate a graded response regarding pain reduction after endometriosis surgery, which is inversely related to disease severity [8][9][10][11]. One randomized controlled trial (RCT) found that pain symptoms improved after endometriosis surgery in significantly more patients with moderate and mild endometriosis (approximately 100% and 70%, respectively) than minimal disease (approximately 40%) [9].…”

Section: Variable Response To Surgerymentioning

confidence: 99%

Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study

et al. 2021

View full text Add to dashboard Cite

Background Endometriosis is a chronic inflammatory condition affecting 6%-10% of women of reproductive age and is defined by the presence of endometrial-like tissue outside the uterus (lesions), commonly affecting the pelvis and ovaries. It is associated with debilitating pelvic pain, infertility, and fatigue and often has devastating effects on the quality of life (QoL). Although it is as common as back pain, it is poorly understood, and treatment and diagnosis are often delayed, leading to unnecessary suffering. Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. Objective This study aims to determine which women with confirmed endometriosis benefit from surgical improvement in pain and QoL and whether these women could be identified from clinical symptoms measured before laparoscopy. Methods First, we will carry out a systematic search and review and, if appropriate, meta-analysis of observational cohort and case-control studies reporting one or more risk factors for endometriosis and postsurgical treatment success. We will search PubMed, Embase, and Cochrane databases from inception without language restrictions and supplement the reference lists by manual searches. Second, we will develop separate clinical prediction models for women with confirmed and suspected diagnoses of endometriosis. A total of three suitable databases have been identified for development and external validation (the MEDAL [ISRCTN13028601] and LUNA [ISRCTN41196151] studies, and the BSGE database), and access has been guaranteed. The models will be developed using a linear regression approach that links candidate factors to outcomes. Third, we will hold 2 stakeholder co-design workshops involving eight clinicians and eight women with endometriosis separately and then bring all 16 participants together. Participants will discuss the implementation, delivery, usefulness, and sustainability of the prediction models. Clinicians will also focus on the ease of use and access to clinical prediction tools. Results This project was funded in March 2018 and approved by the Institutional Research Ethics Board in December 2019. At the time of writing, this study was in the data analysis phase, and the results are expected to be available in April 2021. Conclusions This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. International Registered Report Identifier (IRRID) DERR1-10.2196/20986

show abstract

Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis

Cited by 454 publications

References 22 publications

A Pilot Feasibility Multicenter Study of Patients After Excision of Endometriosis

A Pilot Feasibility Multicenter Study of Patients After Excision of Endometriosis

Neuroimmunomodulatory Alterations in Non-Lesional Peritoneum Close to Peritoneal Endometriosis

Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study

Contact Info

Product

Resources

About