Hysterectomy Is Much Better Than Laparoscopy in Preventing Endometriosis’ Return

Hysterectomy Is Much Better Than Laparoscopy in Preventing Endometriosis’ Return

A lot of women who use laparoscopic surgery to treat their endometriosis see the disease return, according to a study.

Even women who have a hysterectomy — or removal of the uterus — to try to ensure against a recurrence can find their symptoms returning, which means they will need to be retreated.

But those who have a hysterectomy have much lower recurrence rates than those who have laparoscopic surgery. This kind of surgery is much less invasive because doctors use a video camera and several thin instruments to perform it.

The study, “Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy,” was published in the Journal of Women’s Health.

Oral contraceptives, nonsteroidal anti-inflammatory drugs, hormonal analogs and other endometriosis treatments can relieve symptoms, but can’t cure the disease. Surgical removal of diseased tissue is the most effective treatment, but it can’t guarantee a permanent fix, either — and it can have side effects.

Researchers looked at recurrence in 24,915 endometriosis patients who had a hysterectomy and 37,308 who had laparoscopic surgery. The information came from the Truven Health MarketScan Commercial Claims and Encounters database.

Patients who had a hysterectomy were much less likely to need retreated than those who had laparoscopic surgery, the research team found.

A year after the procedure, 2.6 percent of the hysterectomy group needed retreatment. The figures were 3.3 percent at two years, 4.7 percent at five years, and 5.4 percent at eight years. In the laparoscopy group the percentages were 9.4, 15.8, 27.5, and 35.2.

The results suggested that hysterectomy does a much better job than laparoscopy in protecting against the disease recurring.

“The rates in both cohorts increased dramatically after expanding the retreatment definition to include medical treatments [other than surgery],” the researchers wrote. That expansion led to an estimated retreatment rate of “76.0% for hysterectomy and 90.8% for laparoscopy at the end of 8 years.”

Although these retreatment rates were high, “the results showed that patients undergoing hysterectomy experienced an 84% lower risk of retreatment compared to patients with laparoscopy,” the team said.

Studies are needed on the financial burden of the surgery and hospitalizations from endometriosis, the researchers said. They also called for studies about the link between the disease’s severity and need for retreatment. These could provide insight into the connection between progression and the possible outcome of various treatment regimens, they said.