Operative Therapie der Endometriose und ihre Risiken

Zusammenfassung Die operative Therapie stellt eine der Hauptsäulen der Endometriosebehandlung dar. Operationen werden insbesondere bei Schmerzen und Sterilität durchgeführt und führen zu Schmerzlinderung, teilweise auch zu erhöhter Fertilität. Erläutert wird die operative Therapie bei Adenomyosis, peritonealer Endometriose, tief infiltrierender Endometriose und ovarieller Endometriose. Dabei werden die Effekte der Operation auf Schmerzen und Fertilität sowie Rezidive und Risiken diskutiert. Bei Adenomyosis kommen organerhaltende Verfahren und die Hysterektomie zum Einsatz. Bei peritonealer Endometriose wird die Komplettresektion angestrebt, bei tief infiltrierender Endometriose symptomorientierte Komplettresektion. Hierfür kommen zum Teil hochkomplexe Eingriffe mit erhöhtem Komplikationspotenzial zum Einsatz. Bei der ovariellen Endometriose wird die komplette Zystektomie angestrebt. Dabei sind ovarielle Funktion und Kinderwunsch zusätzlich zu beachten. Endometrioseoperationen sind zumindest kurz- bis mittelfristig effektiv hinsichtlich von Schmerzsymptomen. Sie erhöhen die Wahrscheinlichkeit einer Spontankonzeption. Ihre Rolle im Rahmen der assistierten Reproduktion ist noch unklar. Die Indikationsstellung zur Operation sollte daher stets individuell erfolgen. Die Behandlung sollte insbesondere bei tief infiltrierender Endometriose in spezialisierten Zentren erfolgen. Abstract Surgery is one of the main pillars of treatment of endometriosis. Operations are particularly carried out in cases of pain and sterility and lead to alleviation of pain and in some cases also to increased fertility. This article discusses the surgical treatment of adenomyosis, peritoneal endometriosis, deep infiltrating endometriosis and ovarian endometriosis. The effects of operations on pain, fertility, recurrences and risks are discussed. In cases of adenomyosis organ-preserving procedures and hysterectomy can be used. Peritoneal endometriosis is treated by complete resection and deep infiltrating endometriosis by symptom-oriented complete resection. This sometimes involves highly complex interventions with an increased risk of complications. In cases of ovarian endometriosis, a complete cystectomy is strived for. In these cases, ovarian function and desire for children must also be taken into consideration. Operations for endometriosis are effective against pain symptoms, at least in the short-term or mid-term. They also increase the probability of spontaneous conception. The role of surgery in assisted reproduction is still unclear. The indications for surgery should therefore always be assessed on an individual basis. These operations should be performed in specialized centers, especially in cases of deep infiltrating endometriosis. 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Gynäkologe 53, 671–682 (2020). https://doi.org/10.1007/s00129-020-04646-8 Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00129-020-04646-8