Laparoscopic nerve lysis for deep endometriosis improves quality of life and chronic pain levels

Introduction: Endometriosis is a benign, estrogen-dependent and chronic gynaecological condition which is defined as the presence of endometrial glands and stroma at any extrauterine site, and is estimated to affect 7-10% of women. The management of hyperalgesia in patients with endometriosis remains a medical challenge, especially in cases with severe deep infiltrating endometriosis. Best strategy in patients with pelvic nerves involvement is debated and despite few reports of cohorts, little is known regarding the benefit of surgical procedures in these cases which are particularly challenging and carrying a high risk of complications. Aim of study: The primary aim of this retrospective, unicentric cohort study, was to assess the benefit of surgical management of patients with endometriosis infiltrating pelvic nerves in terms of pain, analgesic consumption, and quality of life (QOL). Materials and Methods: A retrospective unicentric cohort study at an Endometriosis referral center at a tertiary care university affiliated medical center. Patients diagnosed with endometriosis that underwent laparoscopic neurolysis for chronic pain were included. Patients rated their pain before and after surgery and differentiated between chronic pain and acute crises. Patients were requested to maintain a record of analgesic consumption and to evaluate their quality-of-life (QOL) before and following surgery by a detailed symptoms questionnaire. Results: Of the 21 patients in our study 15 (71.5%) had obturator nerve involvement, 2 (9.5%) had pudendal nerve involvement and 4 (19%) had other pelvic nerves involvement. Patients were followed for a minimum of 8 months postoperatively. In this population, medical treatment by oral contraceptives improved symptoms in only 28.6%. All but 2 patients (9.6%) had significant chronic pain improvement with a mean decrease of VAS of 3.05 (+2.5). Analgesic habits changed postoperatively with a significant decrease of 66% of patients' daily consumption. Surgery improved QOL in 12 cases (57.1%) and two patients (9.6%) completely recovered with a high QOL. Conclusion: Neurolysis and excision of endometriosis of pelvic nerves results in significant improvement of chronic pelvic pain VAS score, analgesic agent consumption and improvement in neurological results. Such complex procedures require the expertise of senior surgeons specialized in endometriosis.