Endometriosis affects approximately 10% of all women of reproductive
age and results in symptoms of chronic pelvic pain, including
dysmenorrhea, dyspareunia, and infertility [1,2]. The treatment strategy
for endometriosis depends on the age of the patient, extent of the
disease, severity of the symptoms, and the patient's desire for fertility
[3]. Therapeutic options include medication, surgery, or combination
therapy [4]. Although medical treatment is efficient, it is associated
with adverse effects such as delayed pregnancy and recurrence of
disease after treatment cessation. Local excision of endometriosis
can produce good short-term outcomes but this approach has a high
reoperation rate. In advanced disease, hysterectomy is associated
with a low reoperation rate; therefore, the use of hysterectomy is a
viable option for women with severe endometriosis who do not
wish to undergo future pregnancies [5].
With the advancement of surgical techniques, the use of laparoscopic
hysterectomy (LH) has become more frequent. Many studies
have shown that LH results in appreciably reduced morbidity—
in terms of intraoperative blood loss, need for blood transfusion,
length of hospital stay, and rate of surgical complications—than does
abdominal hysterectomy (AH) [6-10]. Indeed, a study demonstrated
that the use of LH is safe and feasible even in the presence of a
myoma (with uterus size equivalent to more than 14 weeks of pregnancy)
[11]. However, these studies were all performed in women
with little or no adhesive gynecologic disease, whereas endometriosis
is usually characterized by such disease. The present study, therefore,
aimed to compare the operative time, blood loss, need for blood
transfusion, length of hospital stay, and both surgical and postoperative
complications in patients with severe pelvic endometriosis who
underwent either LH or AH.