Surgical management of endometriosis.
The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of ongoing controversy. Complete resolution of endometriosis is not yet possible and current therapy has three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; and (3) to delay recurrence for as long as possible. It is possible that a consensus will never be reached on the optimal treatment of minimal and mild endometriosis. In case of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with a gonadotropin-releasing hormone (GnRH) agonist) should be considered as 'first-line' treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should first be undertaken to give our patients the best chance of conceiving naturally. In case of rectovaginal adenomyotic nodules, surgery must be considered as first-line therapy, medical therapy being relatively in-efficacious.
Donnez
Jacques
J
Department of Gynecology, Université Catholique de Louvain, Cliniques Universitaires St-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium. donnez@gyne.ucl.ac.be
Pirard
Céline
C
Smets
Mireille
M
Jadoul
Pascale
P
Squifflet
Jean
J
D004715:Endometriosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D010049:Ovarian Diseases / Q000473:pathology / Q000601:surgery; D010532:Peritoneal Diseases / Q000601:surgery; D012187:Retroperitoneal Space