{"paper_id":"27b74551-e1f9-43fc-a666-d23c69156f83","body_text":"Zusammenfassung\nDiagnostik und Behandlung der Endometriose ist eine Domäne der gynäkologischen Chirurgie. Hingegen bleibt die Frage nach dem Ausmaß der chirurgischen Intervention, um ein Konzeption zu ermöglichen, kontrovers. Dies gilt insbesondere für die Behandlung bei Befall von Kolon und Rektum.\nAls eindeutig vorteilhaft hat sich die chirurgische Eradikation von Endometrioseläsionen bei minimaler und milder Endometriose herausgestellt. Bei Ausbleiben einer Spontankonzeption nach kompletter Operation scheint die Anwendung von ART(„assisted reproduction techniques“)-Maßnahmen (In-vitro-Fertilisierung, IVF) Vorteile gegenüber einer erneuten Operation zu haben.\nFrauen mit großen Endometriomen oder Endometriosezysten sollten chirurgisch behandelt werden, allein um die Follikelpunktion zu erleichtern und das Risiko einer Infektion zu minimieren.\nKommt es nach mehrfachen IVF-Versuchen nicht zur Schwangerschaft und besteht eine symptomlose, aber schwere und sehr ausgedehnte Endometriose, ist eine individuelle, personalisierte Behandlungsstrategie erforderlich. Eine erneute konservative radikale Operation scheint das nachfolgende IVF-Ergebnis eher zu verbessern.\nAbstract\nSurgery remains the mainstay in the diagnosis and management of endometriosis. The extent of surgery to achieve pregnancy in infertile patients with endometriosis is still under debate in particular concerning involvement of the bowel.\nIn women with minimal and mild endometriosis surgical excision or ablation of endometriotic lesions has turned out to be beneficial to reach the goal of pregnancy. In patients who failed to conceive spontaneously after first line surgery, assisted reproduction techniques (ART) seem to be more effective than repeated surgical interventions.\nWomen with larger endometriomas should undergo repeated surgery for better accessibility to the ovaries if it comes to in vitro fertilization (IVF). Infection rate is likely to be reduced after ovum pick-up.\nIn case of failed IVF and severe endometriosis without symptoms a personalized tailored treatment strategy is mandatory probably in favor of second line conservative radical surgery.\nSimilar content being viewed by others\nLiteratur\nPeirce CL, Templeman C, Rossing MA (2012) On behalf of the ovarian cancer association consortium. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol 13:385–394\nLeitlinien Endometriose der DGGG (2013) (S2k): Leitlinien zur Diagnostik und Therapie der Endometriose. Long Version – AWMF Nr. 015/045\nUlrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW (2014) German and Austrian societies for obstetrics and gynecology. Geburtshilfe Frauenheilkd 74(12):1104–1118\nMarcoux S, Maheux R, Bérubé S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337:217–222\nParazzini F (1999) Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi. Hum Reprod 14:1332–1334\nJacobson TZ, Duffy JMN, Barlow D, Farquhar C, Koninckx PR, Olive D (2010) Laparoscopic surgery for subfertility associated with endometriosis. Editorial Group: Cochrane Menstrual Disorders and Subfertility Group. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001398.pub2\nOpøien HK, Fedorcsak P, Byholm T, Tanbo T (2011) Complete surgical removal of minimal and mildendometriosis improves outcome of subsequent IVF/ICSI treatment. Reprod Biomed Online 23:389–395\nAlborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S (2004) A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 82:1633–1637\nHart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2:CD004992. doi:10.1002/14651858\nDonnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F (1996) Large ovarian endometriomas. Hum Reprod 11:641–646\nBenschop L, Farquhar C, van der Poel N, Heineman MJ (2010) Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 11:CD008571\nTsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG (2009) The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 92:75–87\nMatalliotakis I, Mahutte NG, Koukoura O, Arici A (2006) Endometriosis-associated stage IA clear cell ovarian carcinoma in a woman with IVF-ET treatments in the Yale series. Arch Gynecol Obstet 274:184–186\nMoini A, Riazi K, Amid V, Ashrafi M, Tehraninejad E, Madani T, Owj M (2005) Endometriosis may contribute to oocyte retrieval-induced pelvic inflammatory disease: report of eight cases. J Assist Reprod Genet 22:307–309\nDunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W, European Society of Human Reproduction and Embryology (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412. doi:10.1093/humrep/det457\nBianchi PHM, Pereira RMA, Zanatta A, Alegretti JR, Motta ELA, Serafini PC (2009) Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 16:174–180\nStepniewska A, Pomini P, Bruni F, Mereu L, Ruffo G, Ceccaroni M, Scioscia M, Guerriero M, Minelli L (2009) Laparoscopic treatment of bowel endometriosis in infertile women. Hum Reprod 24:1619–1625\nDaraï E, Lesieur B, Dubernard G, Rouzier R, Bazot M, Ballester M (2011) Fertility after colorectal resection for endometriosis: results of a prospective study comparing laparoscopy with open surgery. Fertil Steril 95:1903–1908\nDouay-Hauser N, Yazbeck C, Walker F, Luton D, Madelenat P, Koskas M (2011) Infertile women with deep and intraperitoneal endometriosis: comparison of fertility outcome according to the extent of surgery. J Minim Invasive Gynecol 18:622–628\nVercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG (2006a) Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 21:2679–2685\nNezhat C, Crowgey S, Nezhat F (1989) Videolaseroscopy for the treatment of endometriosis associated with infertility. Fertil Steril 51:237–240\nVercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG (2006b) Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 195:1303–1310\nBallester M, Roman H, Mathieu E, Touleimat S, Belghiti J, Darai E (2017) Prior colorectal surgery for endometriosis-associated infertility improves ICSI-IVF outcomes: results from expert centres. Eur J Obstet Gynecol Reprod Biol 209:95–99\nDarwish B, Roman H (2016) Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol 215(2):195–200\nPagidas K, Falcone T, Hemmings R, Miron P (1996) Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer. Fertil Steril 65:791–795\nAdamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94:1609–1615\nBenaglia L, Somigliana E, Vercellini P, Benedetti F, Iemmello R, Vighi V, Santi G, Ragni G (2010) The impact of IVF procedures on endometriosis recurrence. Eur J Obstet Gynecol 148:49–52\nBenaglia L, Somigliana E, Santi G, Scarduelli C, Ragni G, Fedele L (2011) IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod 26:2368–2372\nD’Hooghe TM, Denys B, Spiessens C, Meuleman C, Debrock S (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86:283–290\nRickes D, Nickel I, Kropf S, Kleinstein J (2002) Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril 78:757–762\nSallam H, Garcia-Velasco J, Dias S, Arici A (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 2:CD004635\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nInteressenkonflikt\nA. Agic und W. Küpker geben an, dass kein Interessenkonflikt besteht.\nDieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.\nAdditional information\nRedaktion\nK. Diedrich, Hamburg\nR. Felberbaum, Kempten\nW. Küpker, Bühl\nRights and permissions\nAbout this article\nCite this article\nAgic, A., Küpker, W. Der Kampf mit der Hydra. Gynäkologe 50, 428–432 (2017). https://doi.org/10.1007/s00129-017-4077-4\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00129-017-4077-4","source_license":"CC0","license_restricted":false}