The Effect of Endometriosis and its Radical Laparoscopic Excision on
Quality of Life Indicators
Full Text Article May be Ordered from the British
Journal of Obstetrics & Gynaecology Online © Copyright in the
journal rests with the Royal College of
Obstetricians and Gynaecologists
Br J Obstet Gynaecol 2000 Jan;107(1):44-54
The Effect of Endometriosis and its Radical
Laparoscopic Excision on Quality of Life Indicators
Garry R, Clayton R, Hawe J, Northern Endometriosis Centre,
St. James's University Hospital, Leeds.
OBJECTIVE: To assess the effect of
endometriosis and radical laparoscopic excision on the quality of life of women
with this condition.
DESIGN: A prospective study.
SETTING: The Northern Endometriosis Centre
at South Cleveland Hospital, Middlesbrough and St. James's University Hospital,
POPULATION: Fifty-seven consecutive
patients undergoing laparoscopic excision of invasive endometriosis.
METHODS: Questionnaires, both
pre-operatively and four-month post-operatively, for a number of different
symptoms associated with endometriosis were completed by patients. Details of
fertility, previous treatments and quality of life as measured by SF12 and
EuroQOL (EQ-5D) and sexual activity questionnaire, as well as linear pain scores
for several symptoms, were recorded. Details of intra-operative findings was
MAIN OUTCOME MEASURES: Effect of
laparoscopic excision on pain scores and quality of life, operative findings,
type of surgery, length of surgery and incidence of intra- and post-operative
RESULTS: Patients with endometriosis
were severely ill with significant pain and impairment of quality of life and
sexual activity. Four months after radical laparoscopic excision for deep
endometriosis there was significant improvement in all the parameters measured
including their quality of life based on EuroQOL evaluation: EQ-5D (0 x 595:0 x
729, P = 0.002) and EQ thermometer (68 x 9:77 x 7, P = 0.008); SF12 physical
score (44 x 8:51 x 9, P = 0.015); sexual activity (habit P = 0.002, pleasure P =
0.002 and discomfort P < or = 0.001). Only the mental health score of SF12
failed to show any statistical improvement (47 x 1:48 x 4, P = 0.84).
Symptomatically, there was a significant reduction in dysmenorrhoea (median 8 x
0:4 x 0, P < or = 0.001), pelvic pain (median 7 x 0:2 x 0, P < or =
0.001), dyspareunia (median 6 x 0:0 x 0, P < 0.001) and rectal pain scores
(median 4 x 0:0 x 0, P < 0.001). Complications were noted, but were
deemed to be acceptable for the extent of the surgery.
CONCLUSIONS: This is an early
analysis of the first 57 cases studied, but structured evaluation suggests that
meaningful improvements in clinical symptoms and quality of life can be obtained
with this approach with acceptable levels of operative morbidity. Further follow
up of this series is required, but early evidence would suggest that the
technique should be further evaluated as part of a randomised trial.
PMID: 10645861, UI: 20108459