Laparoscopic treatment of endometriosis stage III-IV

Objective: The aim of the study was to evaluate the efficacy of conservative surgery at laparoscopy on a series of patients with stage III-IV endometriosis. Methods: Of 158 women undergoing operative laparoscopy for endometriosis stage III-IV, only the patients followed for a minimum of six months (n = 115) were considered. The cumulative proportion of pregnant patients and the cumulative recurrence rate were calculated using the Kaplan-Meyer method. Results: Thirteen pregnancies (37%) occurred in the infertile patients. All pregnancies occurred in patients with stage III endometriosis, whereas no woman with stage IV endometriosis conceived (48% versus 0%, p <0.05). The 18-month cumulative pregnancy rate was 40.5%. We observed two (1.7%) recurrences confirmed by histologic examination, and 12 (11.4%) recurrences documented only by clinical and ultrasonographic findings. In 11 of 14 cases (79%) endometriotic cysts recurred on the same ovary involved by the disease at the first laparoscopy. No recurrence occurred in the first six months of follow-up. The 24 month-cumulative recurrence rate was 38%. The cumulative recurrence rates were significantly different in the patients with cysts equal or larger than 4 cm compared to those with cysts less than 4 cm (19% versus 50%, p <0.05). Conclusions: Operative laparoscopy seems to be an effective treatment for endometriosis stage III-IV. However, extension of the series and a longer follow-up are needed to further clarify the role of operative laparoscopy in the management of advanced endometriosis.