Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis

Objective: To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group.

Design: One-year follow-up of a prospective, randomized, double-blind controlled trial.

Setting: A referral center for the laparoscopic laser treatment of endometriosis.

Patient(s): Sixty-three patients with pelvic pain and minimal to moderate endometriosis.

Intervention(s): After the 6-month follow-up visit, the randomization code was broken, and follow-up was continued to 1 year. Symptomatic patients were offered second-look laser laparoscopy.

Main Outcome Measure(s): Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls.

Result(s): Symptom relief continued at 1 year in 90% of those who initially responded. All symptomatic controls had a second-look procedure, with 7 (29%) showing disease progression, 7 (29%) showing disease regression, and 10 (42%) having static disease.

Conclusion(s): The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year. Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others.     

Growing up with juvenile gastrointestinal polyposis: Report of a case

Summary A case of a boy with juvenile gastrointestinal polyposis, followed for 15 years, is presented. This case appears to be different from those reported by Sachatello and coworkers⁶ in that our patient has no family history of the disorder. The case demonstrates many of the features of juvenile polyposis: onset in infancy, frequent autoamputation and prolapse, severest symptoms in the second year of life, and decreasing polyp formation after reaching teen age. The most important danger in juvenile polyposis lies in possible confusion with familial adenomatous polyposis with consequent performance of radical surgery to prevent cancer.