Yeung, P. P., Jr., Sinervo, K., Winer, W., & Albee, R. B., Jr. (2011). Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertility and Sterility, 95(6), 1909-1912.e1. https://doi.org/10.1016/j.fertnstert.2011.02.037
Yeung PP Jr, Sinervo K, Winer W, Albee RB Jr. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 2011;95(6):1909-1912.e1. doi:10.1016/j.fertnstert.2011.02.037
Yeung, Patrick, Jr., et al. "Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?" Fertility and Sterility, vol. 95, no. 6, 2011, pp. 1909-1912.e1.
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Teens who had second surgery after excision had no endometriosis
Of 17 teenagers with proven endometriosis, 8 had a second operation after excision, and surgeons found no endometriosis in any. This was a prospective case series at one referral center. Follow-up reached 66 months. About one-third took hormonal suppression after surgery. Most pain symptoms improved.
Key Findings
Twenty teenagers had a diagnostic laparoscopy and surgeons removed all abnormal pelvic lining they could identify. Seventeen had endometriosis confirmed by histology.
Follow-up ran up to 66 months, average 23.1 months. Eight of 17 patients (47.1%) returned to surgery for lasting pain. At those operations, surgeons found no endometriosis by sight or on histology.
Dysmenorrhea fell from 82.4% to 41.2% and dyschezia from 76.5% to 17.6%. Chronic pelvic pain (76.5% to 53%) and dyspareunia decreases were not statistically significant.
After surgery, 6 of 17 patients (35.3%) took combination oral contraceptives and 1 of 17 (5.9%) took a GnRH agonist.
Twelve of 16 patients (75%) rated quality of life awful or poor before surgery. Two of 7 (28.6%) rated it poor after (P=.04).
Interpretation
This case series followed 17 teens with confirmed endometriosis after full excision. Follow-up ran up to 66 months. Eight patients had a second surgery for lasting pain. Each time, surgeons found no endometriosis, by eye or under the microscope. Pain from periods and bowel movements dropped. Quality of life improved a great deal, moving most teens from poor or awful to good or excellent. Most of this held with little or no hormonal suppression. The authors note that some quality-of-life scores after surgery were missing. The findings support larger studies of excision as a lasting treatment for endometriosis in teens.
RRM Context
Most of the 17 teens took hormonal suppression before surgery. They still had endometriosis on histology. Suppressive medications control symptoms while the disease stays. Restorative reproductive medicine removes the disease itself. Excision of all visible lesions is the surgical standard. This series adds teens to that record.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine long-term outcomes after complete laparoscopic excision done at a tertiary referral center in a teenager population, who were not specifically advised to take postoperative hormonal suppression.
Design
Prospective observational case series (Canadian Task Force II-3).
Setting
A tertiary referral center that specializes in the laparoscopic treatment of endometriosis.
Patients
Teenagers with symptoms suspicious for endometriosis who consented and were prospectively recruited to participate in the study.
Interventions
All patients underwent diagnostic laparoscopy and complete excision of all areas of abnormal peritoneum with typical and atypical endometriosis. Patients were not specifically advised to take postoperative hormonal suppression.
Main Outcome Measures
Rate of recurrent (or persistent) endometriosis.
Results
Twenty teenagers underwent complete laparoscopic excision of all areas of abnormal peritoneum with typical and atypical endometriosis. Seventeen patients had endometriosis confirmed by histology at initial surgery. Follow-up was up to 66 months (average 23.1 months). There was a statistically significant improvement in most pain symptoms, including bowel-related symptoms, during this time period. The rate of repeat surgery was 8 of 17 patients (47.1%), but the rate of endometriosis (diagnosed visually or histologically) found at surgery was zero. Only one-third of patients took postoperative hormonal suppression for any length of time.
Conclusions
Complete laparoscopic excision of endometriosis in teenagers--including areas of typical and atypical endometriosis--has the potential to eradicate disease. These results do not depend on postoperative hormonal suppression. These data have important implications in the overall care of teenagers, regarding pain management, but also potentially for fertility. Further large comparative trials are needed to verify these results.
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