Bailliere's clinical obstetrics and gynaecology

The complications of hysterectomy are discussed, generally speaking their definition is poorly standardized and direct comparisons are extremely difficult. Furthermore, there is uncertainty as to what is meant by laparoscopic hysterectomy. …

Hysterectomy is the commonest major operation performed by gynaecologists and is the definitive cure for many of it's indications which include dysfunctional uterine bleeding, fibroids, utero-vaginal prolapse, endometriosis and adenomyosis,…

Intestinal and urinary tract involvement by endometriosis may be symptomatic, particularly when invasive disease is present. Even in expert hands, complete excision of all invasive disease cannot be accomplished laparoscopically in every ca…

The effective removal of endometriosis is the major aim of physicians treating patients with pelvic pain. This can now be accomplished long-term as effectively at laparoscopy as at laparotomy (Wheeler and Malinak, 1987; Redwine, 1991; Marti…

In the pelvis, three different forms of endometriosis (Donnez et al, 1992) must be considered: (1) peritoneal, (2) ovarian, (3) rectovaginal septum. By evaluation of the mitotic activity and the stromal vascularization, we have recently sug…

Alternatives to endometrial ablation include re-education of the 20% or more women complaining of menorrhagia whose blood loss is normal, less than 35 ml, and the use of an increasing variety of drugs to find an effective regime with minima…

Endoscopy has replaced laparotomy in nearly all patients requiring surgical treatment of endometriosis. Controlled trials have shown electrosurgery is more effective than expectant treatment in the resolution of infertility due to peritonea…

Laparoscopic hysterectomy is a substitute for abdominal hysterectomy and not for vaginal hysterectomy. Most hysterectomies currently performed with an abdominal approach may be performed with laparoscopic dissection of part or all of the ab…

Recent comparative studies and developments in our understanding of the pathogenesis and pathophysiology of endometriosis have led to increasing doubts about whether it should always be considered a disease. Widespread use of laparoscopy fo…

Cumulative evidence supports the concept of retrograde menstruation being a pelvic aggressor as it contributes to both the development of endometriosis and related symptoms such as dysmenorrhoea and infertility. A major problem in studying …

There is abundant evidence of altered immune function in endometriosis. The task that remains is to attempt a synthesis from the accumulated data, to try to make some sense of the observed phenomena and to fit them into a conceptual framewo…

Screening for endometriosis is subject to general rules. The two most important conditions, i.e. the disorder should be well-defined and serious, and there must be an effective way to treat or prevent it through screening, are not satisfied…

A perfect endometriosis classification should be a common language and an expert system which helps the gynaecologist to decide the treatment of each patient. The staging of endometriosis is not a new idea; the first classification based on…

The majority of patients with pain associated with endometriosis will obtain benefit from the many and varied therapies available for the treatment of endometriosis. The minority who fail to obtain relief from the conventional therapies may…

Despite intense clinical interest and increasingly sophisticated diagnostic techniques, we know surprisingly little of the relationship between endometriosis and infertility or the mechanism of infertility in these couples. No therapy speci…

The management of women with endometriosis is complex and necessitates individualization of patient care. The most commonly used medical therapies are danazol, GnRH agonists, medroxyprogesterone acetate and gestrinone. Studies to date have …

Radical ablative surgery for endometriosis is indicated chiefly for symptoms of pain that fail to respond to conservative treatment. The sites of involvement must be carefully assessed and surgery planned taking account of the wishes of the…

Patient selection is a critical factor in influencing results in assisted reproduction. Patients should be assessed individually in terms of all relevant fertility factors including age, duration and aetiology of infertility and psycho-soci…

For centuries people have been trying to look inside the abdomen but it is only relatively recently that the technology has been available to make this a meaningful possibility. Major milestones have included safe peritoneal insufflation, c…