Ablation of lesions plus laparoscopic uterine nerve ablation (LUNA) in minimal-moderate disease reduces endometriosis-associated pain at 6 months compared to diagnostic laparoscopy; the smallest effect is seen in patients with minimal disease . However, there is no evidence that LUNA is a necessary component, as LUNA by itself has no effect on dysmenorrhoea associated with endometriosis . No RCTs have been conducted to assess the value of surgery for endometriomas or DIE since these would be difficult studies to conduct ethically. However, a number of retrospective studies demonstrate that approximately 80% of women with severe symptoms are pain free following surgery - a figure that clearly exceeds any likely placebo effect.
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