{
    "abstract": "There is no agreed consensus on the optimal surgical treatment for pain associated with endometriosis.\nTo compare improvement in symptoms and quality-of-life in patients undergoing excisional endometriosis surgery (EES) versus EES with hysterectomy and bilateral salpingo-oophorectomy (EES-HBSO).\nThis study evaluated patients undergoing EES and EES-HBSO at a single endometriosis centre between 2009 and 2019. Data was obtained from the British Society for Gynaecological Endoscopy database. Adenomyosis was assessed by blinded re-analysis of imaging and/or histology data.\nPain scores (numeric rating scale 0-10) and quality-of-life scores (EQ-VAS) before and after EES and EES-HBSO.\nWe included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis.\nEES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.",
    "authors": [
        {
            "affiliation": null,
            "firstname": "N",
            "initials": "N",
            "lastname": "Manobharath"
        },
        {
            "affiliation": null,
            "firstname": "J",
            "initials": "J",
            "lastname": "Lewin"
        },
        {
            "affiliation": null,
            "firstname": "M",
            "initials": "M",
            "lastname": "Hirsch"
        },
        {
            "affiliation": null,
            "firstname": "J",
            "initials": "J",
            "lastname": "Naftalin"
        },
        {
            "affiliation": null,
            "firstname": "A",
            "initials": "A",
            "lastname": "Vashisht"
        },
        {
            "affiliation": null,
            "firstname": "A",
            "initials": "A",
            "lastname": "Cutner"
        },
        {
            "affiliation": null,
            "firstname": "E",
            "initials": "E",
            "lastname": "Saridogan"
        }
    ],
    "conclusions": "EES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.",
    "copyrights": null,
    "doi": "10.52054/FVVO.15.1.055",
    "journal": "Facts, views & vision in ObGyn",
    "keywords": [],
    "methods": null,
    "publication_date": "2023-04-04",
    "pubmed_id": "37010333\n35350465\n33368183\n33894154\n35299012\n29632080\n34229185\n28954555\n31550940\n34880044\n24435778\n25845383\n16021068\n19639926\n9572209\n21083863\n20656568\n9544712\n24845364\n33502767\n36029832\n28093732\n17097580\n11821087\n26499878\n7589631\n19384117\n11491192\n32437082\n23048011\n18515510\n35472598\n17646052\n29039055\n31264010\n27168180\n19700151",
    "results": "We included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis.",
    "title": "Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis.",
    "xml": "<Element 'PubmedArticle' at 0x78850568f240>"
}