Date of Award

2027

Document Type

Capstone

Degree Name

Master of Science (MS)

Department

Physician Assistant Studies

Committee Chair

LaDonna Clark

Abstract

Introduction: Endometriosis is a chronic inflammatory disorder characterized by the presence of endometrial-like tissue outside the uterine cavity.1 This disorder affects 6% to 10% of reproductive-aged women and is associated with chronic pain, infertility, and menstrual irregularities.3 Laparoscopy is the gold standard for surgical management of symptomatic disease; however, uncertainty exists regarding whether laparoscopic excision provides better clinical outcomes compared to laparoscopic ablation.4

Methods: A literature search was conducted using the PubMed database with MeSH terms and Boolean operators related to endometriosis, laparoscopy, excision, and ablation. Filters were applied to include English-language, full-free text, randomized controlled trials, systematic reviews, meta-analyses, and published within the last five years. Four high-quality articles were selected for this review including two Cochrane systematic review/meta-analyses, one systematic review, and one randomized controlled trial. These were selected based on their direct relevance to the PICO question and evaluation of meaningful outcomes.

Results: Overall, findings demonstrated laparoscopic excision had decreased recurrence of dysmenorrhea, dyspareunia, endometrioma recurrence, and repeat surgical intervention compared with ablative techniques. Findings also demonstrated that laparoscopic ablative procedures were better for maintaining ovarian reserve with its tissue-preserving technique compared to excisional techniques.

Discussion: The articles included each had different objectives, therefore conclusions were varied. Evidence showed laparoscopic excisional techniques are favorable to reduce pain and recurrence rate; however, laparoscopic ablation was favorable for ovarian preservation and fertility outcomes. Further research is needed with direct comparison of these interventions. Overall, an individualized approach to management of symptomatic endometriosis is recommended.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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