[Surgical treatment of endometriosis]

Endometriosis is defined as a condition with ectopic endometrial tissue outside the uterine cavity, with pain and infertility as the dominating symptoms. The disease affects about 10% of fertile women. We have described the most common manifestations of endometriosis (peritoneal, ovarian and deep endometriosis) with an emphasis on surgical treatment.

This paper is based on literature retrieved from non-systematic searches of Medline and other databases, with an emphasis on randomised and large studies, as well as our own clinical experience and international collaboration.

All gynecological departments should treat peritoneal endometriosis surgically in conjunction with diagnostic laparoscopy. Medical treatment, with amenorrhoea as a goal, relieves pelvic pain, but has no beneficial effect on fertility. ovarian endometriosis should be treated surgically. Upon surgery, the pseudocapsule should be removed, possibly with ablation close to the ovarian hilus to conserve as much functional ovarian tissue as possible. Larger endometriomas- especially kissing ovaries- are often combined with deep endometriosis, and treatment in specialized hospitals should be considered. deep endometriosis must usually be treated surgically. When endometriosis affects the vagina, bowel and/or bladder, surgery is challenging, time-consuming and often involves collaboration with gastrosurgeons and/or urologists. Treatment of these difficult cases should be centralized.