title: [Recurrence of pain after surgery for deeply infiltrating endometriosis: How does it happen? How to manage?].
abstract: Recurrence of deep endometriosis remains a major issue in the management of endometriosis. The main cause for recurrence appears to be an incomplete excisional surgery. Therefore, the goal of the primary surgery should be the complete resection of all endometriotic lesions. If surgical skills cannot meet this objective it seems preferable to refer the patient to a center with a recognized expertise in this field rather than performing an incomplete surgery. It seems also possible to tailor the indications according to the symptoms, especially when endometriosis affects the bladder in association with an asymptomatic vaginal and/or rectal involvement. This strategy does not increase the rate of recurrence. Postoperative medical treatment based on ovarian function suppression is attractive as it diminishes the recurrence rate. Facing the recurrence, appropriate assessment of the benefit risk balance must be performed. Medical treatment is an option. When surgery is chosen, it seems interesting to discuss carefully the indication of hysterectomy with bilateral oophorectomy, especially for women over 40 years old with no desire for pregnancy and/or symptomatic adenomyosis. Risks of induced ovarian castration must be taken into account.
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Inserm U1016, CNRS UMR8104, département génétique développement cancer, institut Cochin, université Paris Descartes, 75014 Paris, France. Electronic address: bruno.borghese@cch.aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Borghese
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Inserm U1016, CNRS UMR8104, département génétique développement cancer, institut Cochin, université Paris Descartes, 75014 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Santulli
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Inserm U1016, CNRS UMR8104, département génétique développement cancer, institut Cochin, université Paris Descartes, 75014 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Streuli
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France.
authors.forename: M-C
authors.initials: MC
authors.lastname: Lafay-Pillet
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: de Ziegler
authors.affiliation: Service de gynécologie obstétrique 2 et médecine de la reproduction, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris Descartes, Sorbonne Paris Cité, AP-HP, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Inserm U1016, CNRS UMR8104, département génétique développement cancer, institut Cochin, université Paris Descartes, 75014 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Chapron
mesh_terms: D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D058990:Molecular Targeted Therapy / Q000639:trends; D009640:Norethindrone / Q000627:therapeutic use; D017699:Pelvic Pain / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D010532:Peritoneal Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D011184:Postoperative Period; D011247:Pregnancy; D012008:Recurrence
chemical_list: D003613:Danazol; D009640:Norethindrone