Endometriosis: modern principles of diagnosis and treatment (literature review). Part 2. Surgery

In: Vestnik of Vitebsk State Medical University · 2020 · vol. 19(1) , pp. 7–12 · doi:10.22263/2312-4156.2020.1.7 · W4232506843
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This review analyzes surgical treatment principles for endometriosis, including indications, approaches, tactics, and postoperative management, alongside surgical management of associated infertility and assisted reproductive technologies.

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This literature review synthesizes current guideline and Cochrane recommendations on surgical management of women with endometriosis, focusing on external genital disease, including indications, surgical tactics, preoperative preparation, and postoperative management. It separately reviews surgical treatment principles related to endometriosis-associated infertility, covering laparoscopic approaches for infertility and medical strategies after endometrioidectomy, and it also discusses roles for assisted reproductive technologies. A major limitation is that the article is an interpretive review rather than an original clinical study, so its conclusions depend on the scope and quality of the cited recommendations and systematic reviews. This paper is centrally about endometriosis — it provides a modern literature-based overview of diagnosis and surgical treatment strategies for endometriosis.

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DOI: https://doi.org/10.22263/2312-4156.2020.1.7 Radeckaya L.E., Dziaikala N.S. Endometriosis: modern principles of diagnosis and treatment (literature review). Part 2. Surgery Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus Vestnik VGMU. 2020;19(1):7-12. Abstract. This review analyzes and summarizes the current recommendations of the World, European and a number of National Professional Associations of Obstetricians-Gynecologists, as well as Cochrane systematic reviews on the treatment of patients with endometriosis. The principles and methods of surgical treatment for external genital endometriosis have been analyzed and described in detail in this paper. The issues of surgical treatment of endometriosis symptoms have also been described in detail: indications, approaches, surgical tactics, preoperative preparation and postoperative management. Taken separately the principles and methods of surgical treatment for endometriosis-associated infertility have been considered including the rules of laparoscopic surgery for infertility and the medical tactics after endometrioidectomy. Attention has been paid to the possibilities of assisted reproductive technologies in endometriosis. Key words: endometriosis, surgical treatment, infertility, endometrioma, assisted reproductive technologies. References 1. Johnson N, Hummelshoj L. Consensus on current management of endometriosis. Hum Reprod. 2013 Jun;28(6):1552-68. doi: http://dx.doi.org/10.1093/humrep/det050 2. Ros o-vo akusherov-ginekologov FGBU, Nauch Tsentr akusherstva ginekologii i perinatologii im VI Kulakova Minzdrava RF, Kaf reproduktiv. meditsiny i khirurgii MGMSU, Nauch-issled in-t akusherstva i ginekologii im DO Otta RAMN, GBUZ MO Mosk obl nauch-issled in-t akusherstva i ginekologii, FGBU Endokrinol nauch Tsentr Minzdrava RF, i dr. Endometriosis: diagnosis, treatment and rehabilitation. Federal Clinical Guidelines for Patient Management. Moscow, RF; 2013. 65 р. (In Russ.) 3. Healey M, Ang WC, Cheng C. Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation. Fertil Steril. 2010 Dec;94(7):2536-40. doi: http://dx.doi.org/10.1016/j.fertnstert.2010.02.044 4. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012 Sep;98(3):564-71. doi: http://dx.doi.org/10.1016/j.fertnstert.2012.07.1061 5. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update. 2009 Mar-Apr;15(2):177-88. doi: http://dx.doi.org/10.1093/humupd/dmn062 6. Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009 Jul-Aug;15(4):441-61. doi: http://dx.doi.org/10.1093/humupd/dmp007 7. Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008 Jun;111(6):1285-92. doi: http://dx.doi.org/10.1097/AOG.0b013e3181758ec6 8. Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004 Oct;82(4):878-84. doi: http://dx.doi.org/10.1016/j.fertnstert.2004.03.046 9. Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012 Dec;98(6):1531-8. doi: http://dx.doi.org/10.1016/j.fertnstert.2012.08.009 10. Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Delpiano EM, Marchino GL, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011 Dec;23(6):740-6. doi: http://dx.doi.org/10.1016/j.rbmo.2011.07.014 11. Hart RJ, Hickey M, Maouris P, Buckett W. Excision surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008 Apr;(2):CD004992. doi: http://dx.doi.org/10.1002/14651858.CD004992.pub3 12. Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2010 Jan;(1):CD001398. doi: http://dx.doi.org/10.1002/14651858.CD001398.pub2 13. Stepniewska A, Pomini P, Scioscia M, Mereu L, Ruffo G, Minelli L. Fertility and clinical outcome after bowel resection in infertile women with endometriosis. Reprod Biomed Online. 2010 May;20(5):602-9. doi: http://dx.doi.org/10.1016/j.rbmo.2009.12.029 14. Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;(3):CD003678. doi: http://dx.doi.org/10.1002/14651858.CD003678.pub2 15. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12. doi: http://dx.doi.org/10.1093/humrep/det457 16. Seracchioli R, Mabrouk M, Frascà C, Manuzzi L, Montanari G, Keramyda A, et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010 Jan;93(1):52-6. doi: http://dx.doi.org/10.1016/j.fertnstert.2008.09.052 17. Costello MF. Systematic review of the treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination. Aust N Z J Obstet Gynaecol. 2004 Apr;44(2):93-102. doi: http://dx.doi.org/10.1111/j.1479-828X.2004.00192.x 18. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep;98(3):591-8. doi: http://dx.doi.org/10.1016/j.fertnstert.2012.05.031 Information about authors: Radeckaya L.E. – Doctor of Medical Sciences, professor of the Chair of Obstetrics & Gynecology, Vitebsk State Order of Peoples’ Friendship Medical University; Dziaikala N.S. – Candidate of Medical Sciences, associate professor of the Chair of Obstetrics & Gynecology, Vitebsk State Order of Peoples’ Friendship Medical University. Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Obstetrics & Gynecology. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Lyudmila E. Radeckaya.

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