Abstract
A cohort of 108 women with chronic pelvic pain underwent a laparoscopy, and a diagnosis of endometriosis was made in 88 (81%). Pre-operative and 2 years post-operative pain scores, using a ranked ordinal scale, were calculated for 44 women with complete pelvic organs (50%) and full data sets. Endometriosis was diagnosed on the basis of histological confirmation of the presence of glands and stroma in excised specimens and endometriosis classified by the American Society of Reproductive Medicine r-ASRM or by the presence of superficial or deep disease. The r-ASRM was a poor predictor of pain relief following surgery, and women with superficial disease did not respond well (in terms of appreciable, reduced pain) to surgical treatment, but good pain relief was seen with some women with nodular or infiltrating ('deep') disease. Women were also asked to complete a General Health Questionnaire. This showed an appreciable degree of depressive morbidity, which improved over the time of the study. Severity of initial global pain scores did not equate to the severity of endometriosis as categorised by either the r-ASRM score or the type of disease. This small study suggests that surgical therapy does not reduce pain scores in superficial endometriosis but is valuable in the treatment of deep or infiltrating disease. Longer-term follow-up of a larger cohort is necessary to evaluate further the value of surgery in this disease and to be further able to develop more accurate predictions of the outcome of surgical intervention in terms of pain relief. © Springer-Verlag 2006.