Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis

Abstract

Objective: To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group.

Design: One-year follow-up of a prospective, randomized, double-blind controlled trial.

Setting: A referral center for the laparoscopic laser treatment of endometriosis.

Patient(s): Sixty-three patients with pelvic pain and minimal to moderate endometriosis.

Intervention(s): After the 6-month follow-up visit, the randomization code was broken, and follow-up was continued to 1 year. Symptomatic patients were offered second-look laser laparoscopy.

Main outcome measure(s): Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls.

Result(s): Symptom relief continued at 1 year in 90% of those who initially responded. All symptomatic controls had a second-look procedure, with 7 (29%) showing disease progression, 7 (29%) showing disease regression, and 10 (42%) having static disease.

Conclusion(s): The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year. Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others.