Study Objective. To evaluate the efficacy of conservative laparoscopic surg
ery in a series of patients with stage Ill-IV endometriosis.
Design. Prospective study (Canadian Task Force classification II-1).
Setting. University-affiliated hospital.
Patients. All 141 women who underwent conservative operative laparoscopy fo
r stage Ill-IV endometriosis between January 1993 and December 1996 and wer
e followed for a minimum of 6 months.
interventions. Laparoscopic procedures performed with scissors, bipolar coa
gulation, and hydrodissection.
Measurement and Main Results. Clinical examination, transvaginal ultrasonog
raphy, and pain questionnaire were scheduled every 6 months postoperatively
. The cumulative proportion of pregnant patients and cumulative recurrence
rate Mere calculated by Kaplan-Meier method. Twenty-five women (44%) with i
nfertility became pregnant. Twenty-three (51%) had stage III and two (16.7%
, p <0.05) had stage IV endometriosis. The 24-month cumulative pregnancy ra
te was 57.5%. Thirty-one women (22 %) reported pain recurrence during follo
w-up. Five (3.5%) recurrences were confirmed by histologic examination and
eight (5.7%) were documented only by clinical and ultrasonographic findings
. No recurrence occurred in the first 6 months of follow-up.
Conclusion. Operative laparoscopy seems to be effective treatment for stage
III endometriosis. A larger series with longer follow-up is necessary to c
larify its role in the management of stage IV disease.