Surgical treatment of endometriosis

Biopsy may be necessary with the non-pigmented and opacified implants to confirm the diagnosis. The surgeon should look for bluish-black implants or papules varying in colour on or under the peritoneal surface, and for deep infiltrating implants in the pouch of Douglas, on and around the uterosacral ligaments and posterior wall of the uterus, under the ovary in the ovarian fossae and rectovaginal septum. Laparoscopy allows a diagnosis of endometriosis to be made along with an assessment of the extent of disease. The extent of surgery is dependent on the preoperative symptoms, the severity of disease, the wishes of the patient and the need for informed consent. Careful preoperative assessment enables a clinical staging and possible surgical difficulties to be anticipated. Bowel preparation should be undertaken where clinical findings and imaging reveal that advanced disease with bowel involvement is present.