Comparison between medical treatment by GnRH analogue (goserelin) and conservative surgery by laparoscopic diathermy for the management of endometriosis

Objective

To compare the effectiveness of medical treatment of endometriosis with conservative surgical treatment, either alone or combined with medical treatment.

Design

Case-controlled, prospective observational clinical study.

Setting

Gynaecology Department at Benenden Hospital, Kent, UK.

Patients

98 women proven laparoscopically to have endometriosis which was staged using the Revised American Fertility Society Classification (rAFS).

Interventions

The first group underwent medical treatment with the GnRH analogue, goserelin (3.6 mg depot) and the second group was treated using laparoscopic diathermy. Some members of the second group who had endometriomas and stage IV endometriosis (AFS classification) also had GnRH analogue in addition to laparoscopic diathermy. There was no statistically significant difference between the age, parity and severity of symptoms of the groups.

Main outcome measures

Variations in patient-reported symptoms, physician-recorded clinical examination and in second-look laparoscopic findings, in each group, 6 months after treatment completion.

Results

Treatment with laparoscopic diathermy, either alone or in combination with GnRH analogue, was associated with a significantly better outcome, as assessed by a self-report of marked improvement in symptom score or cure, compared with treatment with GnRH analogue alone (relative risk 2.36, 95% confidence interval (CI) 1.38–4.02). The surgical treatment group were also 2.52 times more likely to show either marked improvement or cure, as judged by clinical assessment, than the group of patients who received GnRH analogue alone (relative risk 2.52, 95% CI 1.54–4.14). There was an improvement or cure in 71% of patients in the surgical group, when assessed laparoscopically at follow up, compared with 49% in the medical group.

Conclusion

The results showed that patients with endometriosis receiving conservative surgery, either alone or in combination with GnRH analogue, were at least two times more likely to have either marked improvement or cure, as assessed by patient-reported symptoms and clinical findings at 6-month follow up, than those who received GnRH analogue alone.