Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 28456617 · doi:10.1016/j.jmig.2017.04.008
What was done
Authors conducted a systematic review and meta-analysis across multiple databases (including MEDLINE, Embase, Cochrane Library, and trial registries) comparing laparoscopic excision versus laparoscopic ablation for endometriosis-associated pain. Three randomized controlled trials were included, enrolling 335 total participants (sample sizes per study ranging from 24 to 178). Data from 2 studies were pooled for meta-analysis. The primary outcome was visual analog scale (VAS) score reduction for dysmenorrhea; secondary outcomes included VAS changes for dyspareunia, dyschezia, chronic pelvic pain, and Endometriosis Health Profile-30 (EHP-30) core pain scores.
What was found
Pooled meta-analysis showed excision led to a significantly greater reduction in dysmenorrhea (mean difference [MD] = 0.99; 95% CI, -0.02 to 2.00; p = .05) and dyschezia (MD = 1.31; 95% CI, 0.33 to 2.29; p = .009) compared with ablation. Dyspareunia improvement showed a nonsignificant difference (MD = 0.96; 95% CI, -0.07 to 1.99; p = .07). Data from one study showed significant reductions favoring excision for chronic pelvic pain (MD = 2.57; 95% CI, 1.27 to 3.87; p = .0001) and EHP-30 scores (MD = 13.20; 95% CI, 3.70 to 22.70; p = .006).
Why it matters
Laparoscopic excision provides modest pain advantages over ablation for dysmenorrhea, dyschezia, and pelvic pain at 12 months postsurgery. This provides surgical guidance, though the small volume of trial data warrants cautious interpretation.
Limits
The total evidence base is small, comprising only 3 trials with 335 participants, and only 2 studies could be quantitatively pooled. The confidence interval for the primary outcome of dysmenorrhea spanned zero despite a reported p-value of .05. Secondary outcomes like chronic pelvic pain and quality-of-life scores were derived from a single study. Adverse events, complications, reoperation rates, and outcomes beyond 12 months were not reported in the abstract.
Cited by
- supports Laparoscopic surgical resection is the gold standard for diagnosing and treating endometriosis lesions compared to ablation or burning.