Belgin SAVRAN ÜÇOK, Türkan DİKİCİ AKTAŞ, Emel ÖZALP, Özgür Volkan AKBULUT, Kubilay ÇANGA
Journal of Medicine and Palliative Care - 2026;7(2):192-197
Aims: To investigate the relationship between preoperative and postoperative visceral pain scores and the C-reactive protein-albumin-lymphocyte (CALLY) index in patients with endometriosis and to identify predictors of postoperative pain. Methods: This retrospective comparative study included women aged 18-45 years who underwent surgical treatment for stage III-IV endometriosis at Ankara Etlik City Hospital between 2022 and 2024, with postoperative histopathological confirmation of the diagnosis. The control group consisted of healthy women without pelvic pathology who underwent bilateral tubal ligation for sterilization at the same institution during the study period. Preoperative and postoperative (day 7+/-1) blood samples were analyzed for CRP, albumin, and lymphocytes to calculate the CALLY index. Visceral pain was evaluated using a Visual Analogue Scale (VAS). Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative pain after adjusting for surgical type (laparotomy/laparoscopy). Results: Ninety-four endometriosis patients and 120 controls were analyzed. Preoperative and postoperative VAS scores were significantly higher in the endometriosis group than controls (p<0.001). In endometriosis patients, postoperative CALLY index values decreased significantly compared to preoperative levels (p<0.001), and a weak but significant negative correlation was found between postoperative CALLY and VAS scores (rho=-0.214, p=0.038). Multivariate regression identified bilateral endometrioma as the only independent predictor of postoperative visceral pain (adjusted beta=1.311, p<0.001). Conclusion: CALLY index and pain were weakly but significantly correlated postoperatively, indicating that systemic inflammation alone cannot explain endometriosis-related pain. Bilateral endometrioma represents a high-risk phenotype for persistent postoperative pain. Evaluating anatomic burden, inflammatory-nutritional indices, and pain phenotype together may improve individualized pain management strategies.
