Surgical management of endometriosis: surgical techniques, adjuvant therapy, and long-term management Number 10 -...

• Surgical outcomes in endometriosis vary substantially according to disease phenotype, symptom profile, and reproductive priorities. • Excisional surgery for ovarian endometriomas is associated with lower recurrence rates but carries a consistent risk of postoperative ovarian reserve impairment. • Surgery for deep infiltrating endometriosis is associated with meaningful improvement in pain and quality of life when clinical indications are appropriate and execution is precise, but entails higher surgical complexity and morbidity. • Repeat surgical interventions are associated with diminishing symptomatic benefit and increasing cumulative risk, including adhesion-related morbidity and the loss of both organ function and ovarian reserve. • Postoperative hormonal therapy may reduce symptom recurrence and the likelihood of repeat surgery in women not seeking immediate pregnancy. • Endometriosis surgery should be integrated into a long-term, multidisciplinary care model focused on symptom control and quality of life rather than disease eradication.