The influence of peritoneal endometriotic lesions on the generation of endometriosis-related pain and pain reduction after surgical excision
- First Online:
To investigate the influence of different kinds of endometriotic lesions, especially peritoneal endometriotic implants in pain generation and the pain reduction after surgical excision in a prospective study.
Fifty-one pre-menopausal patients underwent surgical laparoscopy due to chronic pelvic pain, dysmenorrhoea and/or for ovarian cysts. In 44 patients, endometriosis was diagnosed. The pre- and post-operative pain score was determined using a standardized questionnaire with a visual analogue scale. Patients with peritoneal endometriosis were divided into two different groups depending on their pre-operative pain score: group A had a pain score of 3 or more, while group B a pain score of 2 or less. Patients without peritoneal endometriosis were classified as group C, and patients without endometriosis were classified as group D. The pre- and post-operative pelvic pain and/or dysmenorrhoea was analysed according to the different types of endometriotic lesions.
In groups A and C, the post-operative pain score decreased by at least 2 grades or more (p < 0.0). In group D, the post-operative pain score showed no significant reduction.
The present study suggests that the surgical excision of endometriotic lesions—including peritoneal implants—is an effective treatment of endometriosis-associated pelvic pain and/or dysmenorrhoea.
KeywordsEndometriosis Pelvic pain Dysmenorrhoea Pain transmission Pathophysiology of endometriosis-related pain Surgical excision
- 9.Mechsner S, Schwarz J, Thode J, Loddenkemper C, Salomon DS, Ebert AD (2007) Growth-associated Gap 43 positive sensory nerve fibers accompanied by immature vessels are located in or near peritoneal endometriotic lesions. Fertil Steril 88(3):583–587. doi:10.1016/j.fertnstert.2006.12.087 CrossRefGoogle Scholar
- 11.Zanetti-Dällenbach R, Bartley J, Müller C, Schneider A, Köhler C (2007) Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy. Surg Endosc 22(4):995–1001PubMedCrossRefGoogle Scholar
- 14.Tamburro S, Canis M, Albuisson E, Dechelotte P, Darcha C, Mage G (2003) Expression of transforming growth factor beta1 in nerve fibers is related to dysmenorrhea and laparoscopic appearance of endometriotic implants. Fertil Steril 80:1131–1136. doi:10.1016/S0015-0282(03)01182-8 PubMedCrossRefGoogle Scholar
- 21.Jones HW Jr JG (1982) Endometriosis. In: Gynecology, 3rd edn. Williams & Wilkins, Baltimore, p 352Google Scholar
- 23.Moon Y, Leung P, Ho Y (1981) Prostaglandin F in human endometriotic tissue. Obstet Gynecol 141:344Google Scholar
- 24.Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG (2007) Association between endometriosis stage, lesion type, patient characteristics and severità of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 22:266–271. doi:10.1093/humrep/del339 PubMedCrossRefGoogle Scholar