Open pelvic surgery for endometriosis

Endometriosis in a significant number of women is a chronic progressive disease with the overwhelming symptom being intractable pain. Hormonal therapy and conservative surgery, either local excision or ablation, offer temporary relief but this is often short-lived and relapse rates are high. When symptomatic relief becomes more important than fertility preservation, surgery, in the form of pelvic clearance followed by hormone replacement therapy (HRT), must be contemplated. The nature of the disease process itself, and the effects of previous surgery – extensive adhesions and fibrotic tissues are the rule – make this definitive surgery extremely challenging. It is therefore axiomatic that experienced surgeons should perform such procedures, and it is for this reason that many of these cases of end-stage disease gravitate to gynecologic oncologists for this form of surgical management.