Surgical Outcomes in Patients With Endometriosis: A Systematic Review

Objective: Among women treated surgically for endometriosisassociated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis.The aim of this study was to assess the efficacy of surgical procedures used to treat endometriosis-associated pain.Methods: Medline and Embase were searched on October 13, 2016.Articles referring to women undergoing surgery for the treatment of endometriosis-associated pain were screened by two independent investigators.For each included treatment arm, data were extracted for the proportion of patients reporting partial or no improvement after surgery for endometriosis-associated pain, pain recurrence, or requirement for further surgery.Results: A total of 38 studies were included.Most studies did not report relevant outcomes to evaluate pain (71.1%) and recurrent surgery (68.4%).Of the women who underwent lesion excision, 11.8% reported no improvement in pain, and 22.6% underwent further surgery.Postoperative pain, recurrent pain, and adverse events were reported by 34.3%, 28.7%, and 14.8%, respectively, of patients who underwent excision or ablation of endometriosis combined with pelvic denervation and in 25.0%, 15.8%, and 8.1% of women who underwent lesion excision alone.Of the patients who were treated surgically for deep endometriosis affecting the bowel and/or bladder, 7.0% experienced recurrent symptoms, and 4.1% underwent further surgery.Conclusion: This review supports the findings of previous studies and highlights the need for standardized reporting and more detailed follow-up after surgery for endometriosis-associated pain. RésuméObjectif : Pour les femmes ayant reçu un traitement chirurgical des douleurs li ees a l'endom etriose, on observe un manque de donn ees sur la proportion de patientes qui eprouvent un soulagement partiel ou inexistant de leurs symptômes, qui connaissent une r ecidive des symptômes ou qui n ecessitent des traitements chirurgicaux suppl ementaires.Cette etude visait a evaluer l'efficacit e des interventions chirurgicales utilis ees pour traiter les douleurs li ees a l'endom etriose.Méthodologie : Des recherches ont et e men ees dans Medline et Embase le 13 octobre 2016.Deux chercheurs ind ependants ont evalu e des articles faisant r ef erence aux femmes qui subissent une intervention chirurgicale pour traiter les douleurs li ees a l'endom etriose.Pour chaque volet de traitement retenu, les donn ees ont et e extraites pour la portion de patientes qui rapportaient une am elioration partielle ou inexistante apr es une intervention chirurgicale pour traiter les douleurs li ees a l'endom etriose, pr esentaient une r ecidive des douleurs ou n ecessitaient une intervention chirurgicale suppl ementaire.Résultats : Un total de 38 etudes ont et e retenues.La plupart des etudes ne rapportaient pas de donn ees pertinentes pour evaluer les douleurs (71,1 %) ni les interventions chirurgicales suppl ementaires (68,4 %).Parmi les femmes qui ont subi une excision des l esions, 11,8 % ont rapport e ne ressentir aucune am elioration des douleurs et 22,6 % ont dû subir une intervention chirurgicale suppl ementaire.