Patient Perception and Experience of Laparoscopic Excision Versus Ablation of Endometriosis: A Crowd-Sourced Comparative Evaluation of Symptom and Quality of Life Outcomes.

STUDY OBJECTIVE

To compare laparoscopic Ablation and Excision in terms of symptom and Quality of Life outcomes as perceived by endometriosis patients.

DESIGN

A Cohort, Method comparison Questionnaire-based study.

SETTING

Endometriosis-focused Social Media site.

PATIENTS

Endometriosis patients with history of Laparoscopic Ablation and Excision.

INTERVENTIONS

On-line questionnaire focused on pre and post procedure (ablation and excision) outcomes across 63 measures in 5 realms: Physical Symptoms, Functional Impact, Psycho-emotional Impact, Social/Sexual Impact, Economic/Educational Impact.

MEASUREMENTS AND MAIN RESULTS

Two hundred and thirty-two respondents with surgical history that included laparoscopic ablation and excision (without concomitant or interposed hysterectomy) identified for ablation only physical symptom improvement of 11.3% and 8.5% for dysmenorrhea and menorrhagia respectively. Ablation provided no significant improvement in any other physical symptom measure. Excision was identified as providing improvements across all symptoms, ranging from 28% to 46%. In terms of functional Impact, ablation provided non-significant improvements or worsening of status. Excision demonstrated significant improvement for patients across most measures of Functional Impact. In terms of Psycho-emotional Impact, a worsening of quality of life status is identified in 23 of 24 measures following ablation. Excision demonstrated improvement in 22 of 24 measures. For Social-Sexual Impact, ablation resulted in worsened status across all measures, with excision demonstrating improvements in all measures, significantly so in most. For Economic/Educational Impact, significant worsening of measures or insignificant improvements were demonstrated following ablation. Excision demonstrated significant improvement in most measures. In all realms, pre-Excision status was worse than pre-Ablation. Allowing for a more focused comparison of ablation and excision, 113 respondents with a surgical history of ablation sequentially followed by excision demonstrated outcomes similar to the larger group: overall worsening of status resulting from ablation and overall improvement in status following excision with pre-Excision morbidity higher than pre-Ablation.

CONCLUSION

In this cohort of patients undergoing laparoscopic endometriosis excision after having undergone endometriosis ablation, the former demonstrated greater beneficial effects over a broad spectrum of symptoms and quality of life measures.