Aim

To assess the short term failure rate of laparoscopic excision of endometriosis. 

Method

A Retrospective case note review of a single surgeon series. 

Cases were identified from a review of surgical waiting lists at a private gynaecology clinic in Christchurch.

Entry criteria were women with symptoms of endometriosis who underwent laparoscopic excision of suspected lesions and follow up information was available for a minimum of 3 months postoperatively.

Data collected included details of age, stage of disease, proportion of positive histology specimens, previous surgery, outcome of treatment at follow up and details of any subsequent surgery.

Treatment failure was defined as the patient reporting no or minimal symptomatic benefit from surgery at 3 months follow up.

Comparison was made between women who had previously undergone excision of endometriosis or not and for women whose histology was negative or positive. 

Results

50 cases were identified over the time period of March 2010 to August 2014. 

12 women had undergone previous surgery for endometriosis.

The age range was 15-46. Mean age was 28.5, median 30.

Overall 9/50 (18%) women experienced no or minimal symptomatic benefit from excisional surgery. 

9/38 (23.7%) women having their first operation did not experience benefit.

All women (12/12) who had undergone previous surgery for endometriosis experienced benefit from surgery.

6/50 (12%) had no histological evidence of endometriosis. 3 (50%) of these women had failed treatment. Therefore 3/9 (33%) of women with failed surgery had negative histology vs 3/41 (7%) who had successful treatment. 

Overall 139 individual specimens were excised, of which 112 (80%) were positive. 

14 (28%) women underwent further surgery. If time allows further details of this group will be available for presentation. 

Discussion

In this series, approximately 1/4 of women undergoing their first procedure for excision of endometriosis had no or minimal improvement in symptoms. Not surprisingly the rate of failure was higher amongst women with negative histology. There were no differences in age or stage. 

All of those women who had previously undergone surgery benefitted from the surgery.

Overall the correlation between surgeon opinion and histology was high. 

Despite some limitations this review provides information that will be useful for counselling patients with suspected endometriosis and will also be used to help design a larger and more robust long term follow up study.