Evaluation of Endometriosis-Associated Pain Scores and Complications after Laparoscopic Surgery in Patients Unresponsive to Medical Treatment

Abstract

Endometriosis is a chronic gynecologic disorder characterized by the presence of endometrial-like tissue outside the uterus, often associated with pelvic pain and infertility. Although several medical treatments exist, many patients experience persistent symptoms that require surgical management. Painful pelvic symptoms are the main reason why women with endometriosis who do not respond to medical options seek treatment. This study aimed to evaluate changes in pelvic pain symptoms before and after laparoscopic endometriosis surgery in patients unresponsive to medication. Medical records of women who underwent laparoscopic surgery for drug-refractory painful pelvic symptoms at a tertiary referral hospital between January 1, 2018, and September 30, 2020, were retrospectively reviewed. A total of 82 eligible participants were included. Patients were categorized as isolated ovarian endometriosis (group 1, n=51) or deep infiltrating endometriosis (group 2, n=31). The groups were compared for changes in visual analogue scale (VAS) scores and perioperative outcomes. Composite intraoperative and postoperative morbidities were analyzed as primary outcome measures, including transfusion requirements and other surgery-related conditions. Laparoscopic endometriosis surgery provided significant pain relief for all pelvic pain symptoms. The degree of postoperative VAS improvement was similar between groups, indicating that symptom improvement was independent of disease localization. Composite intraoperative morbidities were significantly higher in group 2, whereas postoperative morbidities showed no significant difference (p=0.001 and p=0.086, respectively). Laparoscopic endometriosis surgery when performed by experienced surgeons, provides substantial improvement in pelvic pain symptoms. Treatment should be individualized using a patient-centered, multimodal, and interdisciplinary approach.