Surgical management of endometriosis

Abstract

Endometriosis, a common disease affecting about 10 % of women of reproductive age, causes pelvic pain and infertility. Pelvic endometriosis is histologically categorized into peritoneal superficial endometriosis, ovarian endometrioma, and deep infiltrating endometriosis (DIE). Surgical treatment for endometriosis aims to relieve symptoms and preserve fertility, in most cases by restoring anatomy, by lysing adhesions, and by removing endometriotic lesions. Laparoscopic surgery, which is the standard surgical procedure for endometriosis, reduces pelvic pain and improves fertility by means of excision and ablation of endometriotic lesions. Managing endometriomas in women who wish to conceive is controversial because two main risks may occur after conservative surgery: recurrence of the disease and significant reduction in ovarian reserve. Surgical treatment for endometriosis should be tailored to the individual according to clinical presentation and personal wishes. In this chapter, we describe laparoscopic conservative surgery for pelvic endometriosis, particularly for ovarian endometrioma.