Chronic pelvic pain accounts for 10 percent of all gynecology visits; most women with chronic pelvic pain have endometriosis, a condition in which endometrial glands and stroma grow on pelvic surfaces outside the uterus. We evaluated adhesion reformation following laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain in 38 women who had two surgeries as part of this study. Adhesions formed or reformed if they were thicker, in areas of prior adhesions, or if they involved the ovary. Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation following surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation. ? ? We considered the prevalence of appendiceal disease in women with chronic pelvic pain undergoing laparoscopy for possible endometriosis and summarized the literature, to more accurately estimate the prevalence of endometriosis. We found that appendiceal endometriosis, while relatively uncommon in patients with endometriosis (4.1% in our series and 2.8% in a literature review), is rare in the general population (0.4%) suggesting the appendix should be inspected for endometriosis and evidence of non-gynecologic disease in patients with right lower quadrant or pelvic pain. ? ? To better understand endometriosis, chronic pelvic pain and its treatment, we have analyzed a survey of Endometriosis Association members reporting surgical diagnosed endometriosis. Of 1,160 women, 95% of respondents reported pelvic pain, had endured symptoms on average of 16 years, and were young (mean: 36 years), white, and educated. Many women (46%) had tried 3+ medical treatments, and almost 20% took them for 10+ years. Surgical procedures were performed at least 3 times on 42%. Nearly 20% had a hysterectomy or oophorectomy; these procedures were reported as most successful in improving symptoms. Despite reporting various treatments as helpful, women used many different types and endured symptoms for an average of almost two decades, indicating the profound effect of endometriosis on women?s health.? ? We have also considered the relationship between disease severity and patient characteristics in endometriosis by analyzing questionnaires from 1,000 women in the Oxford Endometriosis Gene (OXEGENE) Study. Women were assigned to Group I (rAFS Stage I-II, n=423) or Group II (rAFS Stages III-IV, n=517). Women in Group I were significantly younger on entering the study at symptom onset, seeking medical attention, and diagnosis but the overall time to diagnosis did not differ between groups. The most common symptoms leading to a diagnosis were dysmenorrhea and pelvic pain. Dyspareunia and depression were more common in Group I. In Group II, sub-fertility and an ovarian mass more commonly led to a diagnosis. Sub-fertility remained more common in Group II throughout reproductive life, but birth and miscarriage rates were similar. This study shows differences in characteristics of women with different stages of endometriosis, which may aid future clinical and epidemiological studies. Remarkably, the time to diagnosis was similar between women with different stages of disease.
