Objective: To review demographics and outcome in terms of repeat laparoscopy/ies in two cohorts. Those who received adjuvant hormonal therapy versus those who did not receive hormonal therapy, after laparoscopic excisional surgery for endometriosis.
Design and Methods: Retrospective data collection of 135 women undergoing laparoscopic surgery for endometriosis over a seven year period, by three advanced benign laparoscopic surgeons. Identification of those who had laparoscopic excision of endometriosis, with a positive histopathology finding of endometriosis, through review of patient chart, electronic and histopathology record.
Results: Of 135 women undergoing laparoscopic surgery for endometriosis, 78 women had excision of endometriosis, with positive histology findings. 46% (36/78) received adjuvant hormonal therapy after primary excisional laparoscopy, 54% (42/78) did not. The most common adjuvant treatments were Mirena (61%), COCP (17%), GNRH analogues (14%), Depova (5%) and POP (3%) respectively. Average age was 32 years (range 17-47) in the adjuvant group, and 37 years (range 16-45) in the non-adjuvant group. Average parity and BMI were similar in both groups.
Patients in the adjuvant group had more associated psychomotor comorbidities such as IBS, depression and fibromyalgia compared with those not receiving adjuvant therapy (47% vs 24%).
At laparoscopy surgeons classified disease severity as mild in 44% (n=16), moderate in 39% (n=14) and severe in 17% (n=6) in the adjuvant group, versus mild in 50% (n=21), moderate in 26% (n=11) and severe in 24% (n=10) in the non-adjuvant group.
In the adjuvant group 78% (n=28) of patients had a recurrence of their symptoms following surgery versus 40% (n=17) of patients in the non-adjuvant group.
53% (n=19) required at least one further laparoscopy in the adjuvant group versus 26% (n=11) in the non-adjuvant group. The average interval between initial surgery and subsequent surgery;27 months (range 4-74) in the adjuvant group versus 30 months (range 11-48) in the non-adjuvant group.
Conclusion: Overall those patients that had adjuvant therapy did not seem to fare as well. The adjuvant group were generally younger and had a higher incidence of pre-existing comorbidities. They had a higher frequency of moderate disease reported at primary laparoscopy, with increased patients reporting recurrence of their symptoms necessitating further laparoscopy.