LAPAROSCOPY VERSUS LAPAROTOMY IN CONSERVATIVE SURGICAL-TREATMENT FOR SEVERE ENDOMETRIOSIS

Objective: To determine the outcome of laparoscopy compared with lapar otomy in conservative surgical treatment for severe endometriosis. Des ign: Comparison of nonrandomized historical surgical series, Setting: Two teaching hospitals and referral centers specializing in reparative and reconstructive surgery. Patient(s): A total of 216 patients opera ted for severe endometriosis during a 5-year period. Intervention(s): Conservative surgical treatment at laparoscopy (n = 67) or laparotomy (n = 149) with median follow-up of 24 months, Main Outcome Measure(s): Cumulative probability of pregnancy in previously infertile patients (22 in the laparoscopy group and 70 in the laparotomy group) and cumul ative probability of pain recurrence in subjects with moderate or seve re symptoms before surgery (47 in the laparoscopy group and 108 in the laparotomy group). Result(s): The 24-month cumulative probability of pregnancy according to the Kaplan-Meier method was 44.9% after laparos copy and 62.7% after laparotomy. The 24-month cumulative probability o f symptoms recurrence evaluated with a 0 to 3 point verbal rating scal e was, respectively, 16.4% versus 20.3% for dysmenorrhea, 33.3% versus 15.4% for deep dyspareunia, and 25.0% versus 15.9% for nonmenstrual p ain. The corresponding figures obtained with a 10-point linear analogu e scale were 20.3% versus 24.7%, 28.6% versus 10.4%, and 17.5% versus 20.1%, No difference is statistically significant. Conclusion(s): Lapa roscopy and laparotomy seem equally effective in the treatment of infe rtility and chronic pelvic pain associated with severe endometriosis. However, a trend was observed toward a higher pregnancy rate and lower dyspareunia recurrence rate after surgery for severe endometriosis pe rformed at laparotomy compared with laparoscopy.