Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Ashli Lawson MD MS
Start Date
17-5-2024 12:15 PM
End Date
17-5-2024 12:30 PM
Presentation Type
Oral Presentation
Description
Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.
Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.
Methods/Design: This was a single-site, retrospective cohort study reviewing care of adolescent endometriosis patients who chose surgical management. One-year postop impression of pain management was assessed via chart review performed of encounters from 2009 to 2021.
Results: 59 patients were identified during this study period, majority identified as stage 1 endometriosis. 23.7% underwent diagnostic laparoscopy alone, 76.2% had either ablation or excisional biopsy of endometriosis lesions. These patients did not differ in baseline characteristics such as age, race, insurance, age of menarche, duration of preoperative pain, family history of endometriosis, history of missing school due to pain, and number of endometriosis lesions. Majority of patients (96.6%) chose to have hormonal therapy for endometriosis postop. 55.9% had IUD inserted at time of surgery, 23.7% chose to initiate leuprolide, and the remainder chose combination hormonal contraceptive or progestin only therapy. At one year follow-up, most patients (93.2%) reported pain had either improved or resolved. There was no statistical difference in reported pain amongst those who underwent diagnostic laparoscopy only versus those who underwent ablation and/or biopsy of lesions (p = 0.68). Additionally, there was no statistically significant difference comparing long term pain control amongst hormonal therapies observed.
Conclusions: There appears to be no difference regarding type of operative management of endometriosis on long-term pain management. Regardless, it is encouraging that the majority of patients who chose to undergo surgical management reported improvement in their chronic pain. Knowing these outcomes may help guide providers regarding type of surgical management utilized for patients diagnosed with endometriosis.
Included in
Obstetrics and Gynecology Commons, Pediatrics Commons, Surgical Procedures, Operative Commons
Pain Outcomes in Adolescents with Surgically Confirmed Endometriosis: A Single Site Retrospective Cohort Analysis
Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.
Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.
Methods/Design: This was a single-site, retrospective cohort study reviewing care of adolescent endometriosis patients who chose surgical management. One-year postop impression of pain management was assessed via chart review performed of encounters from 2009 to 2021.
Results: 59 patients were identified during this study period, majority identified as stage 1 endometriosis. 23.7% underwent diagnostic laparoscopy alone, 76.2% had either ablation or excisional biopsy of endometriosis lesions. These patients did not differ in baseline characteristics such as age, race, insurance, age of menarche, duration of preoperative pain, family history of endometriosis, history of missing school due to pain, and number of endometriosis lesions. Majority of patients (96.6%) chose to have hormonal therapy for endometriosis postop. 55.9% had IUD inserted at time of surgery, 23.7% chose to initiate leuprolide, and the remainder chose combination hormonal contraceptive or progestin only therapy. At one year follow-up, most patients (93.2%) reported pain had either improved or resolved. There was no statistical difference in reported pain amongst those who underwent diagnostic laparoscopy only versus those who underwent ablation and/or biopsy of lesions (p = 0.68). Additionally, there was no statistically significant difference comparing long term pain control amongst hormonal therapies observed.
Conclusions: There appears to be no difference regarding type of operative management of endometriosis on long-term pain management. Regardless, it is encouraging that the majority of patients who chose to undergo surgical management reported improvement in their chronic pain. Knowing these outcomes may help guide providers regarding type of surgical management utilized for patients diagnosed with endometriosis.
