Excisional Surgery: Medical Data
- No drugs known to eradicate disease or result in long term cure. Garry ‘97 Br J Obstet Gynaecol
- Medical therapy does not improve fertility for mild, moderate or severe disease. Based on RCTs (Cochrane) Lok 2000. (Many of the major classes of drugs have significant side effects , eg osteoporosis. Discontinuation of drugs usually results in pain recurrence within 12 months.
- Danazol v GnRH No difference in subjective pain relief or objective disease at 6 months. 40% recurrence at 12 months. Prentice ‘2000 Cochrane review. Meta-analysis of 15 RCTs involving 1299 patients revealed no difference between Danazol & Gn RH at 6 months & 40% recurrence rates at 12 months. Other studies suggest the side effects of the drugs are a critical factor in compliance.
- Ablation/excision mild to moderate disease increases fertility & gives long term symptom improvement. Marcoux ‘97 NEJM – Sutton ‘94 Fertil & Steril
- Excellent long term results with excision without hysterectomy. Reich, Redwine, Wood, Garry. Ablation is not suitable for deeply invasive disease or when adjacent to vital structures. Redwine remarkable paper. 359 consecutive patients between 1980 & 1990. Criterion for inclusion was that all visible endometriosis could be excised at laparoscopy. Low rate of persistent or recurrent disease refutes the traditional thinking that endometriosis is a highly progressive disease despite treatment & that hysterectomy & oophorectomy are warranted.
- Excision – Recurrent or persistent disease 19% @ 5 years. Redwine ‘91 Fertil & Steril Significant & sustained pain relief up to 4 years following excision. Redwine ‘95. Redwine ‘95. Study of >500 cases. Significant reduction in pelvic pain scores, dyspareunia & painful bowel movements after extensive excision.