Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits.

In this report on the therapeutic results in patients with moderate and severe endometriosis treated by operative laser laparoscopy, we also present a comparative analysis of cost and duration of hospitalization and of convalescence in comparable patients treated by laparoscopy versus laparotomy. Sixty patients treated by the same surgeon with operative laser laparoscopy were followed for a period of at least one year to calculate cumulative pregnancy rates, monthly fecundity rates, and monthly probability of pregnancy. The mean duration of hospitalization and incapacitation as well as physician and hospital costs incurred by the laparoscopy treated patients were compared with those incurred by 60 patients with similar degrees of endometriosis but treated by microsurgery at laparotomy. In the laparoscopy group, 36 patients had stage III and 24, stage IV endometriosis. Monthly fecundity rates (6.7%), monthly probability of pregnancy (12.6%) and cumulative pregnancy rates (70.5%) did not differ between patients with stage III and IV disease. The total number of hospital days required by the 60 laparoscopy patients was 72 versus 258 for the laparotomy patients (P less than .001). The total number of days' incapacitation for laparoscopy patients was 216 versus 1,284 for the laparotomy group (P less than .001). The total cost of medical care was $223,260 for the laparoscopy group and $424,500 for the laparotomy group (P less than .001). Our results validate the therapeutic efficacy of operative laparoscopy in the treatment of moderate and severe endometriosis and confirm the substantial economic and social benefits of laparoscopy surgery over laparotomy.