Conservative surgery for severe endometriosis: should laparotomy be abandoned definitively?
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This review of recent literature indicates insufficient evidence to definitively abandon laparotomy for severe endometriosis, particularly for complex lesions, despite advances in laparoscopy.
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Abstract
According to current opinion, surgery at laparotomy for conservative treatment of endometriosis is obsolete. The debate on the indications, modalities and results of surgical treatment for the most severe forms has recently been rekindled. Although some expert endoscopists propose advanced techniques to deal with the most problematic pelvic lesions, various authors wonder if such interventions have been demonstrated as efficacious and safe enough to justify abandoning the standard reference treatment. We have reviewed the data, comments and proposals recently published on the topic. The available scientific evidence appears insufficient to recommend laparoscopy instead of surgery at laparotomy, even for the most severe forms of endometriosis. Intestinal, vesical, periureteral, retroperitoneal, and vaginal lesions and large endometriomas associated with extensive dense adhesions may still benefit from classical surgery at laparotomy. However, the lack of comparative studies prevents a correct comparison of the methods in terms of pregnancy rate, resolution of pain and incidence of recurrences.
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Cited by (29)
- [Colorectal endometriosis surgery: Technical and technological innovations in service of a complex surgery] 2025
- Cistectomía parcial laparoscópica por endometriosis vesical Laparoscopic partial cystectomy for bladder endometriosis 2010
- An investigation of the surgical treatment of endometriosis 2010
- Endometriose 2009
- Deep endometriosis: a review 2009
- Endometriosis infiltrante: revisión de tema Deep endometriosis: a review 2009
- Endometriosis in patients with chronic pelvic pain: is staging predictive of the efficacy of laparoscopic surgery in pain relief? 2006
- Surgical treatment of deep endometriosis and risk of recurrence 2005
- Laser surgery for endometriosis 2005
- Endometriose 2005
- Laser surgery for endometriosis 2005
- Laparoskopische Therapie der Endometriose 2005
- Current status of management of endometriomas 2004
- Surgical management of deeply infiltrating endometriosis: an update 2004
- Endometriosis: preoperative and postoperative medical treatment 2003
- Laparoscopic management of patients with endometriosis and chronic pelvic pain 2003
- Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification 2003
- Histopathological extent of rectal invasion by rectovaginal endometriosis 2003
- [Deep pelvic endometriosis: management and proposal for a "surgical classification"] 2003
- Endometriosis is a Surgical Disease 2003
- Die chlrurglsche Therapie cler moderated und cler schweren Endometriose 2002
- Management of ovarian endometriomas 2002
- Laparoscopic treatment of endometrioma-associated infertility and pregnancy outcome 2002
- Medical and surgical therapies for pain associated with endometriosis 2001
- Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation 1998
- Biases in the endometriosis literature. Illustrated by 20 years of endometriosis research in Leuven 1998
- Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis 1996
- Modern surgical approaches to female reproductive tract 1996
- Laparoscopic treatment of symptomatic endometriosis 1996
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