A Pilot Study To Evaluate The Clinical Relevance Of Endometriosis-associated Nerve Fibers In Peritoneal Endometriotic Lesions And Pain Reduction After Surgical Excision

Objective:To investigate the clinical relevance of endometriosis-associated nerve fibers in the development of endometriosis-associated symptoms and the pain reduction after laparoscopyical surgical excision in a prospective study.Design:Prospective nonrandomized study.Setting:Department of Obstetrics and Gynecology of university hospital.Patient(s):Seventy-seven premenopausal patients underwent surgical laparoscopy because of chronic pelvic pain,dysmenorrhea,or for ovarian cysts.Endometriosis was diagnosed in 70 patients.Intervention(s):The preoperative and postoperative pain scores were determined using a standardized visual analogue scale from 0-10.Patients with peritoneal endometriosis were divided into two groups depending on their preoperative pain score:group A with a pain score of at least 3 or more and group B with a pain score of 2 or less.Patients without peritoneal endometriosis were classified as group C and patients without endometriosis were classified as group D.Immunohistochemical analysis of neurofilament was used for nerve fiber detection.Occurrence of endometriosis-associated nerve fibers was correlated with the severity of pelvic pain and/or dysmenorrhea.Result(s):Peritoneal endometriosis-associated nerve fibers were found significantly more frequently in group A than in group B(82.9%vs.30.0%). Patients with dysmenorrhea and/or pelvic pain had a significantly higher frequency of nerve fibers in peritoneal endometriotic lesions than patients without those symptoms(83.7%vs.20.0%).In groups A and C,the post-operative pain score decreased significantly(p＜0.05).In group D,the post-operative pain score showed no significant reduction.The post-operative of patients with dysmenorrhea and/or pelvic pain had a significant decrease(p＜0.05).Conclusion(s):The present study suggests that the presence of endometriosis-associated nerve fibers in the peritoneum is important for the development of endometriosis-associated pelvic pain and dysmenorrheal,and that the surgical excision of endometriotic lesions-including peritoneal implants-is an effective treatment of endometriosis-associated pelvic pain and/or dysmenorrhoea.