Chapter 79: Recurrence of Endometriosis after PEARS

Hilgers TW

Endometriosis · Surgical Treatment

Chapter 79: Recurrence of Endometriosis after PEARS

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 1069-1074, 2004

RRM Academy Synopsis

Endometriosis recurred less often after surgical NaProTECHNOLOGY

A 2004 textbook chapter reports that, among women who had repeat laparoscopy, endometriosis came back less often after surgical NaProTECHNOLOGY than after cautery or drug therapy. Excision sites showed less endometriosis at follow-up than laser vaporization sites. Almost all recurrent lesions in the surgical groups were small.

Key Findings

Among women who came for repeat laparoscopy after earlier cauterization, GnRH agonist therapy or danazol elsewhere, the chapter reports a nearly universal recurrence rate.
Persistent or new endometriosis was found significantly less often after surgical NaProTECHNOLOGY than after those earlier treatments, a difference the chapter calls statistically highly significant.
Endometriosis scores at second-look laparoscopy were significantly lower than scores at the first surgery after both laser laparoscopy and laser laparotomy, and lower than in the cautery and drug group.
Videotapes showed significantly less endometriosis at excision sites after laser laparotomy than at vaporization sites after laser laparoscopy; persistent lesions were more common after laparoscopy and new areas after laparotomy.
Almost all recurrent sites in the two surgical groups were small, and the chapter reports that most treated women needed no second-look laparoscopy.

RRM Context

Surgical NaProTECHNOLOGY treats endometriosis at its source by removing the lesions. This matches the restorative aim of correcting the cause of disease. The chapter follows single surgical sites on videotape and compares excision with laser vaporization, lesion by lesion. A site-by-site record like this supports excision as the surgical standard for endometriosis. Cautery and suppressive drugs leave the cause in place. The chapter reports nearly universal recurrence after them, a finding consistent with the restorative view of suppression and ablation.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter examines the recurrence of endometriosis after treatment and argues that most published recurrence studies are deeply flawed, in part because repeat laparoscopy is performed only in women who have a reason to return. Of 76 patients previously treated elsewhere with laparoscopic cauterization, GnRH agonist or danazol, 75 had endometriosis at repeat laparoscopy. Among 46 patients treated with surgical NaProTECHNOLOGY who had second-look laparoscopy, persistent or new endometriosis was found in 65.2 percent, compared with 98.7 percent of the traditionally treated group. At the treated sites, 92.8 percent of excision sites at laser laparotomy and 77.7 percent of vaporization sites at laser laparoscopy showed no endometriosis at follow-up, a difference the chapter reports as significant (p=.0044), and 77 of 82 recurrent sites were less than 1 cm in size.

Topics

Endometriosis › Surgical Treatment › Recurrence After Surgery · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Restorative Reproductive Medicine › NaProTechnology › Program Outcomes

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 79: Recurrence of Endometriosis after PEARS

Endometriosis recurred less often after surgical NaProTECHNOLOGY

Key Findings

RRM Context

Abstract

Topics

By this author

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