Follow-up of laparoscopic treatment of stage III-IV endometriosis

Study Objective. To evaluate the efficacy of conservative laparoscopic surgery in a series of patients with stage Ill-IV endometriosis. Design. Prospective study (Canadian Task Force classification II-1). Setting. University-affiliated hospital. Patients. All 141 women who underwent conservative operative laparoscopy for stage Ill-IV endometriosis between January 1993 and December 1996 and were followed for a minimum of 6 months. interventions. Laparoscopic procedures performed with scissors, bipolar coagulation, and hydrodissection. Measurement and Main Results. Clinical examination, transvaginal ultrasonography, and pain questionnaire were scheduled every 6 months postoperatively. The cumulative proportion of pregnant patients and cumulative recurrence rate Mere calculated by Kaplan-Meier method. Twenty-five women (44%) with infertility became pregnant. Twenty-three (51%) had stage III and two (16.7%, p <0.05) had stage IV endometriosis. The 24-month cumulative pregnancy rate was 57.5%. Thirty-one women (22 %) reported pain recurrence during follow-up. Five (3.5%) recurrences were confirmed by histologic examination and eight (5.7%) were documented only by clinical and ultrasonographic findings. No recurrence occurred in the first 6 months of follow-up. Conclusion. Operative laparoscopy seems to be effective treatment for stage III endometriosis. A larger series with longer follow-up is necessary to clarify its role in the management of stage IV disease.