Radical, Fertility-Sparing Surgery Improves Pain : Early results are called 'encouraging' in the first study reporting treatment outcomes in adolescents.


LONDON — Radical, fertility-sparing excision of severe endometriosis in adolescent girls can eliminate or greatly improve pain, reported Andreas I. Stavroulis, M.D., at the annual congress of the International Society for Gynecologic Endoscopy.

“This is the first study reporting the outcome of radical excision treatment for severe endometriosis in this age-group, and early results are encouraging,” reported Dr. Stavroulis of the endometriosis unit, University College London Hospitals.

Dr. Stavroulis and his colleagues reviewed the cases of 31 girls under age 20 years who underwent laparoscopy to investigate chronic pelvic pain, which had failed to respond to medical treatment.

No pelvic abnormalities were found in 11 patients, and endometriosis was detected in 11. Other diagnoses included four nonfunctional nonendometriotic ovarian cysts, one functional ovarian cyst, one bilateral and one unilateral hydrosalpinx, and two obstructed uterine horns.

Of the 11 patients with endometriosis, 6 had severe disease that was treated with radical excision, and there were no complications. Five were rendered pain free, while one had improved symptoms, he said.

“Our follow-up is only short to medium term—up to 112 weeks—but we are going to follow them further to see if they have any future problems,” he said.

Endometriosis and laparoscopy are not commonly considered in adolescent girls with chronic pelvic pain, partly because of a misconception among many generalists that the disease is rare in this age-group, Dr. Stavroulis said.

In fact, it is the most common reason for chronic pelvic pain that is nonresponsive to medical therapy, and there is evidence in the literature that endometriosis can occur as early as premenarche in some girls, he said.

However, even when the disease is recognized, many physicians hesitate to treat it surgically. “It's not an easy decision. You obviously have to make sure that the girl and her parents appreciate that these operations do have risks. But if you have tried all the other alternatives, like medical therapy, and if you see severe endometriosis on laparoscopy—then why not?”

Dr. Stavroulis said parents must be informed that while endometriosis itself may cause problems with infertility, radical excision may cause adhesions that could also interfere with fertility.

This image shows a teen with severe endometriosis. Courtesy Dr. Andreas I. Stavroulis

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