[Surgical management of endometriosis--an overview]

Laparoscopy is the treatment of choice in the diagnostics of endometriosis. Surgical management of early-stage endometriosis at the time of diagnosis is to be aimed at. Resection of peritoneal endometriosis is essential; coagulation/ablation may be an alternative. In the early stages, pain reduction is as effective as by drug therapy. Surgery improves fertility in these stages. Complete removal of an endometrioma lowers the recurrence rate and improves fertility. In cases of definitive surgical therapy, i.e. hysterectomy and adnexectomy, any accompanying endometriosis focuses have to be carefully resected. When clinically symptomatic, a deep endometriosis has to undergo radical surgery. In these cases, assisted reproduction is usually necessary when such a patient wants to become pregnant. The recurrence rate after complete surgical management of a serious endometriosis is lower compared to drug therapy; pain reduction is more effective. A postoperative drug therapy with GnRH analogues, danazole or gestagen does not improve fertility, the interval to a recurrence is however positively influenced. Hormonal replacement therapy after definitive surgical management has probably no influence on the recurrence rate.