Der Kampf mit der Hydra

Zusammenfassung Diagnostik 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. Als 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. Frauen mit großen Endometriomen oder Endometriosezysten sollten chirurgisch behandelt werden, allein um die Follikelpunktion zu erleichtern und das Risiko einer Infektion zu minimieren. Kommt 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. Abstract Surgery 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. In 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. 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Küpker, Bühl Rights and permissions About this article Cite this article Agic, A., Küpker, W. Der Kampf mit der Hydra. Gynäkologe 50, 428–432 (2017). https://doi.org/10.1007/s00129-017-4077-4 Published: Issue date: DOI: https://doi.org/10.1007/s00129-017-4077-4