Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink?

Re: Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink?

“…We have read the commentary by Horne et al 1 and agree with the authors: placebocontrolled surgical trials for superficial peritoneal endometriosis (SPE) are needed. Such designs are the gold standard of testing treatment efficacy for chronic pain 2 and without placebo-control, it is ultimately unknown whether women with SPE are subjected to repeated surgeries that are not only unnecessary but also potentially harmful.…”

“…First, when there is genuine doubt about the effect of a standard treatment (such as surgery for SPE, as described by Horne et al 1 ), placebo-controlled designs are needed to ascertain whether the treatment is effective. 2 For women with SPE, the placebo arm can be operationalised as a diagnostic laparoscopy without histology.…”

Re: Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink?

“…First, we want to stand in support of the arguments put forth by Horne et al 1 Second, we would like to supplement the commentary with two additional suggestions. First, we want to stand in support of the arguments put forth by Horne et al 1 Second, we would like to supplement the commentary with two additional suggestions.…”

“…The aim of our letter is two-fold. First, we want to stand in support of the arguments put forth by Horne et al 1 Second, we would like to supplement the commentary with two additional suggestions. In both clinical practice and future clinical trials, we believe that clinicians should: (1) adopt a greater focus on the subtyping of endometriosis with imaging to improve preoperative planning; and (2) standardise the evaluation of various pain aetiologies that may complicate the response to the surgical treatment of SPE.…”

“…We have read the commentary by Horne et al, 1 published in this journal, with great interest. The management of pelvic pain and endometriosis presents one of the greatest challenges for gynaecologists worldwide.…”