Radikalitat der operativen Therapie bei Endometriose

Background Endometriosis is a common disease of adult women which can cause pain and infertility and may lead to deterioration of organs. One treatment option is surgical resection. Aim In view of the current literature, the indications for surgical resection and the procedure based on the severity of the endometriosis are discussed.

Surgical resection leads in many cases to increased pregnancy rates and decreased pain. These operations can also be associated with major complications such as bowel and bladder dysfunction and insufficiency of anastomosis. Operation of ovarian endometriomas causes loss of oocytes; therefore, the indication for surgery should be very carefully considered taking advantages and disadvantages into account as well as the psychological strain and age of the patient. When both uterosacral ligaments are affected, radical treatment should be limited in order to maintain bladder function. The same should be done when there is a desire to become pregnant and deep endometriosis is found near/at the uterus or recurrent at the ovaries. Nevertheless, radical resection has its value in therapy of deep-infiltrating endometriosis because it leads to the lowest recurrence rates and there is data that it increases pregnancy rates. Complete multivisceral resection must be planned and performed by an interdisciplinary team of gynaecologists, visceral surgeons, and urologists.

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