{"paper_id":"dde55286-c970-4a32-8fc2-0b3fcd3a0a5a","body_text":"Zusammenfassung\nHintergrund\nEndometriose ist eine weit verbreitete Erkrankung mit vielen Gesichtern. Die operative Therapie ist immer noch nicht standardisiert.\nFragestellung\nIn diesem Beitrag sollen die Standardoperationen insbesondere im Hinblick auf die Fertilität betrachtet werden.\nErgebnisse\nOperatives Ziel ist die komplette Entfernung der Endometriose und damit die Verbesserung der Fertilität. Sollte der Eingriff die Fertilität als übergeordnetes Ziel gefährden, kann es notwendig sein, Residuen zu belassen.\nAbstract\nBackground\nEndometriosis is a widespread disease with many different appearances. There is still no standardized form of surgical treatment.\nObjective\nThis article highlights the standard surgical techniques especially with respect to the impact on fertility.\nResults\nThe aim of surgery is the complete removal of the endometriosis and therefore an improvement in fertility. If there is a risk of compromising the overriding aim of preserving fertility, it may be necessary to leave some residual endometriosis in place.\nSimilar content being viewed by others\nLiteratur\nBenagiano G, Brosens I (2006) History of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20(4):449–463. https://doi.org/10.1016/j.bpobgyn.2006.01.007\nUlrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW, German and Austrian Societies for Obstetrics and Gynecology (2014) National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis (Leitlinie für die Diagnostik und Therapie der Endometriose). Geburtshilfe Frauenheilkd 74(12):1104–1118. https://doi.org/10.1055/s-0034-1383187\nFreis A BM, Strowitzki T, Dietrich JE (2017) Relative kinetic data defining cleavage synchronicity are altered in Embryos from patients with and without endometriosis using time-lapse embryo assassment. World Congress on Endometriosis, Vancouver 17–20.05.2017, oral presentation, MS06-05\nEbert AD, Ulrich U, Keckstein J, Muller M, Schindler AE, Sillem M, Tinneberg HR, De Wilde RL, Schweppe KW, Endometriosis Research F, European Endometriosis L (2013) Implementation of certified endometriosis centers: 5‑year experience in German-speaking Europe. Gynecol Obstet Invest 76(1):4–9. https://doi.org/10.1159/000346457\nCarfagna P, De Cicco Nardone C, De Cicco Nardone A, Testa AC, Scambia G, Marana R, De Cicco Nardone F (2017) The role of transvaginal ultrasound in the evaluation of ureteral involvement in deep Endometriosis. Ultrasound Obstet Gynecol. https://doi.org/10.1002/uog.17524\nSchweppe KW, Ring D (2002) Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle. Fertil Steril 78(4):763–766\nAmerican Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 67(5):817–821\nBühler K (1998) Diagnostik der Endometriose. Endometriose. Kohlhammer, Stuttgart\nMarcoux S, Maheux R, Berube S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337(4):217–222. https://doi.org/10.1056/NEJM199707243370401\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(5):1332–1334\nJacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D (2010) Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001398.pub2\nOpoien HK, Fedorcsak P, Byholm T, Tanbo T (2011) Complete surgical removal of minimal and mild endometriosis improves outcome of subsequent IVF/ICSI treatment. Reprod Biomed Online 23(3):389–395. https://doi.org/10.1016/j.rbmo.2011.06.002\nMuzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB (2014) The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod 29(10):2190–2198. https://doi.org/10.1093/humrep/deu199\nYu HT, Huang HY, Lee CL, Soong YK, Wang CJ (2015) Side of ovarian endometrioma does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy. J Obstet Gynaecol Res 41(5):717–721. https://doi.org/10.1111/jog.12633\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 (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412. https://doi.org/10.1093/humrep/det457\nYang XH, Ji F, AiLi A, TuerXun H, He Y, Ding Y (2014) Effects of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy, and outcome recurrence. Clin Exp Obstet Gynecol 41(3):272–275\nPark H, Kim CH, Kim EY, Moon JW, Kim SH, Chae HD, Kang BM (2015) Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis. Obstet Gynecol Sci 58(6):481–486. https://doi.org/10.5468/ogs.2015.58.6.481\nCentini G, Afors K, Murtada R, Argay IM, Lazzeri L, Akladios CY, Zupi E, Petraglia F, Wattiez A (2016) Impact of laparoscopic surgical management of deep endometriosis on pregnancy rate. J Minim Invasive Gynecol 23(1):113–119. https://doi.org/10.1016/j.jmig.2015.09.015\nCohen J, Thomin A, Mathieu D’Argent E, Laas E, Canlorbe G, Zilberman S, Belghiti J, Thomassin-Naggara I, Bazot M, Ballester M, Darai E (2014) Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. Minerva Ginecol 66(6):575–587\nSchonman R, Dotan Z, Weintraub AY, Bibi G, Eisenberg VH, Seidman DS, Goldenberg M, Soriano D (2013) Deep endometriosis inflicting the bladder: long-term outcomes of surgical management. Arch Gynecol Obstet 288(6):1323–1328. https://doi.org/10.1007/s00404-013-2917-6\nTuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HR (2005) ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 127(5):275–281. https://doi.org/10.1055/s-2005-836904\nIversen ML, Seyer-Hansen M, Forman A (2017) Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review. Acta Obstet Gynecol Scand 96(6):688–693. https://doi.org/10.1111/aogs.13152\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(7):1619–1625. https://doi.org/10.1093/humrep/dep083\nFerrero S, Anserini P, Abbamonte LH, Ragni N, Camerini G, Remorgida V (2009) Fertility after bowel resection for endometriosis. Fertil Steril 92(1):41–46. https://doi.org/10.1016/j.fertnstert.2008.04.070\nOsada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O (2011) Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online 22(1):94–99. https://doi.org/10.1016/j.rbmo.2010.09.014\nGrimbizis GF, Mikos T, Tarlatzis B (2014) Uterus-sparing operative treatment for adenomyosis. Fertil Steril 101(2):472–487. https://doi.org/10.1016/j.fertnstert.2013.10.025\nKishi Y, Yabuta M, Taniguchi F (2014) Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril 102(3):802–807 e801. https://doi.org/10.1016/j.fertnstert.2014.05.028\nMartinez-Conejero JA, Morgan M, Montesinos M, Fortuno S, Meseguer M, Simon C, Horcajadas JA, Pellicer A (2011) Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation. Fertil Steril 96(4):943–950. https://doi.org/10.1016/j.fertnstert.2011.07.1088\nDueholm M (2017) Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand 96(6):715–726. https://doi.org/10.1111/aogs.13158\nMijatovic V, Florijn E, Halim N, Schats R, Hompes P (2010) Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI. Eur J Obstet Gynecol Reprod Biol 151(1):62–65. https://doi.org/10.1016/j.ejogrb.2010.02.047\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nInteressenkonflikt\nF. Neis, K. J. Neis und K. Bühler geben an, dass kein Interessenkonflikt besteht.\nDieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.\nAdditional information\nRedaktion\nG. Griesinger, Lübeck\nRights and permissions\nAbout this article\nCite this article\nNeis, F., Neis, K.J. & Bühler, K. Operative Therapie der Endometriose und Fertilität. Gynäkologische Endokrinologie 15, 273–280 (2017). https://doi.org/10.1007/s10304-017-0154-y\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s10304-017-0154-y\nSchlüsselwörter\n- Peritoneale Endometriose\n- Ovarialendometriose\n- Endometriose der Blase\n- Adenomyose\n- Tiefinfiltrierende Endometriose","source_license":"CC0","license_restricted":false}