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Archives of Gynecology and Obstetrics

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01-09-2009 | Original Article

The influence of peritoneal endometriotic lesions on the generation of endometriosis-related pain and pain reduction after surgical excision

Authors: Andrea Kaiser, Andreas Kopf, Christine Gericke, Julia Bartley, Sylvia Mechsner

Published in: Archives of Gynecology and Obstetrics | Issue 3/2009

Abstract

Purpose

To investigate the influence of different kinds of endometriotic lesions, especially peritoneal endometriotic implants in pain generation and the pain reduction after surgical excision in a prospective study.

Methods

Fifty-one pre-menopausal patients underwent surgical laparoscopy due to chronic pelvic pain, dysmenorrhoea and/or for ovarian cysts. In 44 patients, endometriosis was diagnosed. The pre- and post-operative pain score was determined using a standardized questionnaire with a visual analogue scale. Patients with peritoneal endometriosis were divided into two different groups depending on their pre-operative pain score: group A had a pain score of 3 or more, while group B a pain score of 2 or less. Patients without peritoneal endometriosis were classified as group C, and patients without endometriosis were classified as group D. The pre- and post-operative pelvic pain and/or dysmenorrhoea was analysed according to the different types of endometriotic lesions.

Results

In groups A and C, the post-operative pain score decreased by at least 2 grades or more (p < 0.0). In group D, the post-operative pain score showed no significant reduction.

Conclusion

The present study suggests that the surgical excision of endometriotic lesions—including peritoneal implants—is an effective treatment of endometriosis-associated pelvic pain and/or dysmenorrhoea.

Giudice LC, Kao LC (2004) Endometriosis. Lancet 364:1789–1799. doi:10.1016/S0140-6736(04)17403-5 PubMedCrossRef

Vernon MW, Beard JS, Graves K, Wilson EA (1986) Classification of endometriotic implants by morphologic appearance and capacity to synthesize prostaglandin F. Fertil Steril 46:801–806PubMed

Fedele L, Parazzini F, Bianchi S, Arcaini L, Candiani GB (1990) Stage and localization of pelvic endometriosis and pain. Fertil Steril 53:155–158PubMed

Vercellini P, Bocciolone L, Vendola N, Colombo A, Rognoni M, Fedele L (1991) Peritoneal endometriosis. Morphologic appearance in women with chronic pelvic pain. J Reprod Med 36:533–536PubMed

Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG (1996) Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril 65:299–304PubMed

Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV (1999) Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 6:429–434. doi:10.1016/S1074-3804(99)80006-1 PubMedCrossRef

Gruppo Italiano per lo Studio dell’ Endometriosi (2001) Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain. Hum Reprod 16:2668–2671. doi:10.1093/humrep/16.12.2668 CrossRef

Tokushige N, Markham R, Russell P, Fraser IS (2006) Nerve fibres in peritoneal endometriosis. Hum Reprod 21(11):3001–3007. doi:10.1093/humrep/del260 PubMedCrossRef

Mechsner S, Schwarz J, Thode J, Loddenkemper C, Salomon DS, Ebert AD (2007) Growth-associated Gap 43 positive sensory nerve fibers accompanied by immature vessels are located in or near peritoneal endometriotic lesions. Fertil Steril 88(3):583–587. doi:10.1016/j.fertnstert.2006.12.087 CrossRef

10.

The American Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 67:817–821. doi:10.1016/S0015-0282(97)81391-X CrossRef

11.

Zanetti-Dällenbach R, Bartley J, Müller C, Schneider A, Köhler C (2007) Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy. Surg Endosc 22(4):995–1001PubMedCrossRef

12.

Dworkin RH, Turk DC, Farrar JT et al (2005) Core outcome measures for chronic pain clinical trial: IMMPACT recommendations. Pain 113:9–19. doi:10.1016/j.pain.2004.09.012 PubMedCrossRef

13.

Garry R (2004) The effectiveness of laparoscopic excision of endometriosis. Endoscopic surgery. Curr Opin Obstet Gynecol 16(4):299–303PubMedCrossRef

14.

Tamburro S, Canis M, Albuisson E, Dechelotte P, Darcha C, Mage G (2003) Expression of transforming growth factor beta1 in nerve fibers is related to dysmenorrhea and laparoscopic appearance of endometriotic implants. Fertil Steril 80:1131–1136. doi:10.1016/S0015-0282(03)01182-8 PubMedCrossRef

15.

Whiteside JL, Falcone T (2003) Endometriosis-related pelvic pain: what is the evidence? Clin Obstet Gynecol 46:824–830. doi:10.1097/00003081-200312000-00012 PubMedCrossRef

16.

Berkley KJ, Dmitrieva N, Curtis KS, Papka RE (2004) Innervation of ectopic endometrium in a rat model of endometriosis. Proc Natl Acad Sci USA 101:11094–11098. doi:10.1073/pnas.0403663101 PubMedCrossRef

17.

Berkley KJ, Rapkin AJ, Papka RE (2005) The pains of endometriosis. Science 308:1587–1589. doi:10.1126/science.1111445 PubMedCrossRef

18.

Anaf V, Simon P, El Nakadi I, Fayt I, Buxant F, Simonart T, Peny MO, Noel JC (2000) Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 15:1744–1750. doi:10.1093/humrep/15.8.1744 PubMedCrossRef

19.

Tokushige N, Markham R, Russell P, Fraser IS (2006) High density od small nerve fibers in the functional layer of the endometrium in women with endometriosis. Hum Reprod 21(3):782–787. doi:10.1093/humrep/dei368 PubMedCrossRef

20.

Tokushige N, Markham R, Russell P, Fraser IS (2007) Different types of small nerve fibers in eutopic endometrium and myometrium in women with endometriosis. Fertil Steril 88(4):795–803. doi:10.1016/j.fertnstert.2006.12.078 PubMedCrossRef

21.

Jones HW Jr JG (1982) Endometriosis. In: Gynecology, 3rd edn. Williams & Wilkins, Baltimore, p 352

22.

Drake TS, O’Brien WF, Ramwell PW, Metz SA (1981) Peritoneal fluid thromboxane B2 and 6-keto-prostaglandin F1 alpha in endometriosis. Am J Obstet Gynecol 140:401–404PubMed

23.

Moon Y, Leung P, Ho Y (1981) Prostaglandin F in human endometriotic tissue. Obstet Gynecol 141:344

24.

Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG (2007) Association between endometriosis stage, lesion type, patient characteristics and severità of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 22:266–271. doi:10.1093/humrep/del339 PubMedCrossRef

Title: The influence of peritoneal endometriotic lesions on the generation of endometriosis-related pain and pain reduction after surgical excision
Authors: Andrea Kaiser
Andreas Kopf
Christine Gericke
Julia Bartley
Sylvia Mechsner
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 3/2009
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-008-0921-z

At a glance: The STEP trials

Springer Medicine

The influence of peritoneal endometriotic lesions on the generation of endometriosis-related pain and pain reduction after surgical excision

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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