Top

Archives of Gynecology and Obstetrics

Published in:

01-02-2015 | General Gynecology

Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery

Authors: S. Angioni, A. Pontis, M. Dessole, D. Surico, C. De Cicco Nardone, I. Melis

Published in: Archives of Gynecology and Obstetrics | Issue 2/2015

Abstract

Purpose

To evaluate the role of post-surgical medical treatment with GnRHa in patients with DIE (Deep Infiltrating Endometriosis) that received complete or incomplete surgery laparoscopic excision.

Methods

Hundred fifty-nine patients with deep infiltrating endometriosis of the cul-de-sac and of the rectovaginal septum with pelvic pain undergoing laparoscopic surgery in academic tertiary-care medical center. Eighty patients underwent complete laparoscopic excision of DIE (Arm A) while 79 patients underwent incomplete surgery (Arm B). After surgery each surgical arm was randomized in two groups: no treatment groups 1A [40 pts] and 1B [40 pts] and GnRHa treatment for 6 months groups 2A [40 pts] and 2B [39 pts]. Pain recurrence and quality of life were evaluated in follow-up of 12 months and compared between groups.

Results

No differences were observed between patient groups 1A and 2A. Groups 1A, 2A and 2B obtained significantly lower pain scores than those achieved by the group 1B undergoing incomplete surgical treatment and no post-surgical therapy. At 1-year follow-up patients treated with en-block resection (Groups 1A and 2A) showed the lowest pain scores and the highest quality of life in comparison with the other two groups (Group 1B and 2B).

Conclusion

GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment. It seems that it has no role on post-surgical pain when the surgeon is able to completely excise DIE implants.

Vercellini P, Frontino G, Pietropaolo G, Gattei U, Daguati R, Crosignani PG (2004) Deep endometriosis: definition, pathogenesis, and clinical management. J Am Assoc Gynecol Laparosc 11(2):153–161PubMedCrossRef

Pontis A, Arena I, Angioni S (2014) Umbilical endometriosis primary site without pelvic endometriosis and previous surgery: a case report. Giorn It Ostet Ginecol 24(2):336–338

Melis I, Agus M, Pluchino N, Melis GB, Angioni S (2014) Alexithymia in women with deep endometriosis? A pilot study. J Endometr 6(1):26–33CrossRef

Angioni S, Peiretti M, Zirone M, Palomba M, Mais V, Gomel V, Melis GB (2006) Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without bowel involvement: surgical treatment and long term follow-up. Hum Reprod 21(6):1629–1634PubMedCrossRef

Litta P, D’Agostino G, Conte L, Saccardi C, Cela V, Angioni S, Plebani M (2013) Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma. Gynecol Endocrinol 29(5):452–454PubMedCrossRef

Angioni S, Maricosu G, Mereu L, Mencaglia L, Melis GB (2011) Single port access laparoscopic (SPAL) for endometrioma excision. J Endometr 2(2):95-96

Mencaglia L, Mereu L, Carri G, Arena I, Khalifa H, Tateo S, Angioni S (2013) Single port entry-are there any advantages? Best Pract Res Clin Obst Gynaecol 27(3):441–455CrossRef

Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparoscopically assisted vaginal resection of rectovaginal endometriosis. ObstetGynecol 96:304–307

Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac-de-sac associated with endometriosis: long-term follow-up en bloc resection. FertilSteril 76:358–365

10.

Pisanu A, Deplano D, Angioni S, Ambu R, Uccheddu A (2010) Rectal perforation from endometriosis in pregnancy: case report and literature review. World J Gastroenterol 16(5):648–651PubMedCentralPubMedCrossRef

11.

Dlugi AM, Miller JD, Knittle J (1990) Lupron study group. Lupron depot in the treatment of endometriosis: a randomized, placebo controlled double-blind study. Fertil Steril 54:419–427PubMed

12.

Wheeler JM, Knittle JD, Miller JD (1992) Depot leuprolide versus danazol in treatment of women with symptomatic endometriosis: I. Efficacy results. Am J ObstetGynecol 167:1367–1371CrossRef

13.

Parazzini F, Fedele L, Busacca M, Falsetti L, Pellegrini S, Venturini PL et al (1994) Postsurgical medical treatment of advanced endometriosis: results of a randomized clinical trial. Am J Obstet Gynecol 171:1205–1207PubMedCrossRef

14.

Vercellini P, Crosignani PG, Fadini R, Radici E, Belloni C, Sismondi P (1999) A gonadotrophin-releasing hormone agonist compared with expectant managment after conservative surgery for symptomatic endometriosis. Br J ObstetGynaecol 106:672–677CrossRef

15.

Busacca M, Somigliana E, Bianchi S, De Marinis S, Calia C, Candiani M, Vignali M (2001) Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III–IV: a randomized controller trial. Human Reprod 16:2399–2402

16.

Socolov R, Butureanu S, Angioni S, Sindilar A, Boiculese L, Cozma L, Socolov D (2011) The value of serological markers in the diagnosis and prognosis of endometriosis: a prospective case-control study. Eur J Obstet Gynecol Reprod Biol 154(2):215–217PubMedCrossRef

17.

Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P (2012) Comparison between transvaginalsonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol 40(4):464–469PubMedCrossRef

18.

Danilidis A, PantelisA, Dinas K, Angioni S, Carcea F (2012) Indications of diagnostic hysteroscopy, a brief review of the literature. Gynecol Surg 9(1):23–28

19.

Di Spiezio Sardo A, Bettocchi S, Spinelli M, Guida M, Nappi L, Angioni S, Sosa Fernandez LM, Nappi C (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Min Invasive Gynecol 17(4):436–448CrossRef

20.

Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HR (2005) ENZIAN-score, a classification of deep infiltrating endometriosis. ZentralblGynakol 127(5):275–281

21.

Biberoglu KO, Beherman SJ (1981) Dosage aspects of danazol therapy in endometriosis: short-term effectiveness. Am J Obstet Gynecol 139:645–650PubMed

22.

Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF36) healthy survey questionnaire: normative data for adults of working age. BMJ 306:1437–1440PubMedCentralPubMedCrossRef

23.

Rizzo A, Spedicato M, Mutinati M, Minoia G, Angioni S, Jirillo F, Pantaleo M, Sciorsci RL (2010) Peritoneal adhesions in human and veterinary medicine: from pathogenesis to therapy: a review. Immunopharmacol Immunotoxicol 32(3):481–494PubMedCrossRef

24.

Jones CJ, Inuwa IM, Nardo LG, Litta P, Fazleabas AT (2009) Eutopic endometrium from women with endometriosis shows altered ultrastructure and glycosylation compared to that from healthy controls–a pilot observational study. Reprod Sci 16(6):559–567PubMedCrossRef

25.

Locci R, Nisolle M, Angioni S, Foidart JM, Munaut C (2013) Expression of the gamma 2 chain of laminin-332 in eutopic and ectopic endometrium of patients with endometriosis. Reprod Biol Endocrinol 11(1):94PubMedCentralPubMedCrossRef

26.

Guerriero S, Ajossa S, Gerada M, Virgilio B, Angioni S, Melis GB (2008) Diagnostic value of transvaginal “tenderness-guided” ultrasonography for the prediction of location of deep endometriosis. Hum Reprod 23(11):2452–2457PubMedCrossRef

27.

Garry R (1997) Laparoscopic excision of endometriosis: the treatment of choice. Br J ObstetGynaecol 104:513–515CrossRef

28.

Chapron C, Jacob S, Debuisson JB, Vieira M, Liaras E, Fauconnier A (2001) Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum. Acta ObstetGynecol Scand 80:349–354

29.

Chapron C, Vieira M, Chopin N, Balleyguier C, Barakat H, Dumontier I et al (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound ObstetGynecol 24:175–179

30.

Franke HR, van de Weijer PHM, Pennings TMM, van der Mooren MJ (2000) Gonadotropin-releaswing hormone agonist plus “add-back” hormone replacement therapy for treatment of endometriosis: a prospective, randomized, placebo-controlled, double blind trial. FertilSteril 74:534–539

31.

Friedman AJ, Hornstein MD (1993) Gonadotropin-releasing hormone agonist plus estrogen-progestin “add-back” therapy for endometriosis-related pelvic pain. FertilSteril 60:236–241

32.

Lyndsay PC, Shaw RW, Bennink HJ, Kicovic P (1996) The effect of add-back treatment with tibolone (Livial) on patients treated with gonadotropin-releasing hormone agonist triptorelin (Decapeptyl). FertilSteril 65:342–348

33.

Paoletti AM, Serra GG, Cagnacci A, Vacca AM, Guerriero S, Solla E, Melis GB (1996) Spontaneous reversibility of bone loss induced by gonadotropin-releasing hormone analog treatment. FertilSteril 65:707–710

34.

Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20(8):2317-2CrossRef

35.

Seracchioli R, Mabrouk M, Manuzzi L, Vicenzi C, Frascà C, Elmakky A, Venturoli S (2009) Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod 24:2729–2735PubMedCrossRef

Title: Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery
Authors: S. Angioni
A. Pontis
M. Dessole
D. Surico
C. De Cicco Nardone
I. Melis
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-014-3411-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2015

Risk factors for cancer of cervix, status of screening and methods for its detection

Decidualization of uterine adenomyoma in a pregnant woman: a case report with immunohistochemical study

Diagnostic and therapeutic advancements for aerobic vaginitis

Perioperative and postoperative complications after Ophira mini sling operations

Conservative management of corpus luteum haemorrhage in patients on anticoagulation: a report of three cases and review of literature

Cotyledonoid dissecting leiomyoma of the uterus: report of two cases