Medical and Surgical Management of Endometriosis

In: How to Perform Ultrasonography in Endometriosis · 2018 · pp. 13–26 · doi:10.1007/978-3-319-71138-6_2 · W2896629643
book-chapter OA: closed CC0 ⤵ 1 in-corpus citation
Full text JSON View on OpenAlex View at publisher
AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-12

Endometriosis, a chronic disease impacting women's quality of life with pain and infertility, is treated medically via hormonal therapy or surgically to remove lesions, with imaging aiding treatment planning.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text

This paper provides an overview of medical versus surgical management of endometriosis, focusing especially on deep endometriosis, discussing hormonal approaches (inducing a hypoestrogenic state to atrophy or suppress lesions and reduce inflammatory status) and surgical approaches (restoring normal anatomy by removing lesions). It also describes how imaging, including ultrasonography and MRI, is used to assess the number, size, and anatomical localization of deep endometriotic nodules to support treatment planning. The major limitation explicitly reflected in the text is that it is a narrative/overview chapter rather than a single empirical study, with evidence details largely deferred to cited sources. This paper is centrally about endometriosis — it reviews how deep endometriosis is managed medically (hormonal suppression) and surgically, and how imaging guides lesion mapping for treatment planning.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Full text 23,440 characters · extracted from oa-doi-fallback · 2 sections · click to expand

Abstract

Endometriosis is a chronic, multifactorial disease, affecting predominantly healthy young women with a negative impact on quality of life [1]. It is associated mostly with pelvic pain, dyspareunia, and intestinal disorders and can lead to infertility. Treatment of deep endometriosis (DE) can be either hormonal, aiming at inducing a hypoestrogenic state, atrophy or quiescence of endometriotic lesions, and a reduction of the chronic peritoneal inflammatory status, [2] or surgical, aiming at restoring the normal anatomy by removing endometriotic lesions. In order to plan an appropriate medical or surgical treatment of this condition, imaging (ultrasonography and magnetic resonance imaging (MRI)) is useful for assessing the number, size, and anatomical localization of the endometriotic nodules [3, 4]. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Giudice LC, Kao L. Endometriosis. Lancet. 2004;364:1789–99. Practice Committee of American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2008;90:S260–9. Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, Zupi E. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril. 2014;102:143–50. Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27:2765–75. Berlanda N, Somigliana E, Frattaruolo MP, Buggio L, Dridi D, Vercellini P. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67–71. Bedaiwy MA, Alfaraj S, Yong P, Casper R. New developments in the medical treatment of endometriosis. Fertil Steril. 2017;107:555–65. Ahmad G, O’Flynn H, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2012;2:CD006583. Zupi E, Lazzeri L, Centini G. Deep endometriosis: less is better. J Endometr Pelvic Pain Disord. 2015;7:2. Vercellini P, Somigliana E, Consonni D, Frattaruolo MP, De Giorgi O, Fedele L. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod. 2012;27:3450–9. Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N. Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol. 2004;191:1539–42. Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21:329–39. Vercellini P, Crosignani PG, Somigliana E, Berlanda N, Barbara G, Fedele L. Medical treatment for rectovaginal endometriosis: what is the evidence? Hum Reprod. 2009;24:2504–14. Vercellini P, Giudice L, Evers JL, Abrao MS. Reducing low-value care in endometriosis between limited evidence and unresolved issues: a proposal. Hum Reprod. 2015;30:1996–2004. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101:927–35. Vercellini P, Crosignani P, Somigliana E, Vigano` P, Frattaruolo MP, Fedele L. ‘Waiting for Godot’: a commonsense approach to the medical treatment of endometriosis. Hum Reprod. 2011;26:3–13. Remorgida V, Abbamonte HL, Ragni N, Fulcheri E, Ferrero S. Letrozole and norethisterone acetate in rectovaginal endometriosis. Fertil Steril. 2007;88:724–6. Muzii L, Tucci CD, Feliciantonio MD, Galati G, Verrelli L, Donato VD, Marchetti C, Panici PB. Management of Endometriomas. Semin Reprod Med. 2017;35:25–30. Dunselman GA, Vermeulen N, Becker C, et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29: 400–12. Leyland N, Casper R, Laberge P, Singh SS, SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010;32(7 Suppl 2):S1–S32. Menakaya U, Infante F, Condous G. Consensus on current management of endometriosis. Hum Reprod. 2013;28:3162–3. Harada T, Momoeda M, Taketani Y, Hoshiai H, Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2008;90:1583–8. Vercellini P, Eskenazi B, Consonni D, et al. Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2011;17:159–70. Vercellini P, de Giorgi O, Mosconi P, Stellato G, Vicentini S, Crosignani PG. Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis. Fertil Steril. 2002;77:52–61. Seracchioli R, Mabrouk M, Manuzzi L, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009;24:2729–35. Vercellini P, Barbara G, Somigliana E, et al. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril. 2010;93:2150. Kauppila A, Vierikko P, Isotalo H. Cytosol estrogen and progestin receptor concentrations and 17β-hydroxysteroid dehydrogenase activities in the endometrium and endometriotic tissue. Effects of hormonal treatment. Acta Obstet Gynecol Scand. 1984;63:45–9. Vierikko P, Kauppila A, Ronnberg L, Vihko R. Steroidal regulation of endometriosis tissue: lack of induction of 17β-hydroxysteroid dehydrogenase activity by progesterone, medroxyprogesterone acetate, or danazol. Fertil Steril. 1985;43:218–24. Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database Syst Rev. 2012;3:CD002122. Hapgood JP, Africander D, Louw R, Ray RM, Rohwer JM. Potency of progestogens used in hormonal therapy: toward understanding differential actions. J Steroid Biochem Mol Biol. 2013;142:39–47. Stanczyk FZ, Hapgood JP, Winer S, Mishell DR Jr. Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev 2013;34:171–208. Vercellini P, Pietropaolo G, De Giorgi O, Pasin R, Chiodini A, Crosignani PG. Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril. 2005;84(5):1375–87. Ferrero S, Camerini G, Ragni N, et al. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25:94. Morotti M, Sozzi F, Remorgida V, Venturini PL, Ferrero S. Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment. Eur J Obstet Gynecol Reprod Biol. 2014;183:188–92. Vercellini P, Bracco B, Mosconi P, Roberto A, Alberico D, Dhouha D, Somigliana E. Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. Fertil Steril. 2016;105:734–43. Petraglia F, Hornung D, Seitz C, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285:167–73. Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril. 2001;75:485–8. Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011;95:492–6. Abou-Setta AM, Houston B, Al-Inany HG, Farquhar C. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev. 2013;1:CD005072. Wong AY, Tang LC, Chin RK. Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010;20:273–9. Greenblatt RB, Dmowski WP, Mahesh VB, Scholer HF. Clinical studies with an antigonadotropin-Danazol. Fertil Steril. 1971;22:102–12. Crosignani P, Olive D, Bergqvist A, Luciano A. Advances in the management of endometriosis: an update for clinicians. Hum Reprod Update. 2006;12:179–89. Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Endometriosis: current therapies and new pharmacological developments. Drugs. 2009;69:649–75. Igarashi M, Iizuka M, Abe Y, Ibuki Y. Novel vaginal danazol ring therapy for pelvic endometriosis, in particular deeply infiltrating endometriosis. Hum Reprod. 1998;13:1952–6. Shaw RW. GnRH analogues in the treatment of endometriosis-rationale and efficacy. In: Thomas EJ, Rock JA, editors. Modern approaches to endometriosis. London: Kluwer Academic Publishers; 1990. p. 257–74. Hornstein MD, Yuzpe AA, Burry KA, Heinrichs LR, Buttram VL Jr, Orwoll ES. Prospective randomized double-blind trial of 3 versus 6 months of nafarelin therapy for endometriosis associated pelvic pain. Fertil Steril. 1995;63:955–62. Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up. Obstet Gynecol. 2002;99:709–19. Prentice A. Regular review: endometriosis. BMJ. 2001;323:93–5. Surrey ES. Gonadotropin-releasing hormone agonist and add-back therapy: what do the data show? Curr Opin Obstet Gynecol. 2010;22:283–8. Küpker W, Felberbaum RE, Krapp M, Schill T, Malik E, Diedrich K. Use of GnRH antagonists in the treatment of endometriosis. Reprod Biomed Online. 2002;5:12–6. Finas D, Hornung D, Diedrich K, Schultze-Mosgau A. Cetrorelix in the treatment of female infertility and endometriosis. Expert Opin Pharmacother. 2006;7:2155–68. Diamond MP, Carr B, Dmowski WP, et al. Elagolix treatment for endometriosis-associated pain: results from a phase 2, randomized, double-blind, placebo-controlled study. Reprod Sci. 2014;21:363–71. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009;2:CD004753. Hayes EC, Rock JA. COX-2 inhibitors and their role in gynecology. Obstet Gynecol Surv. 2002;57:768–80. Dogan E, Saygili U, Posaci C, et al. Regression of endometrial explants in rats treated with the cyclooxygenase-2 inhibitor rofecoxib. Fertil Steril. 2004;82:1115–20. Buelke-Sam J, Bryant HU, Francis PC. The selective estrogen receptor modulator, raloxifene: an overview of nonclinical pharmacology and reproductive and developmental testing. Reprod Toxicol. 1998;12:217–21. Swisher DK, Tague RM, Seyler DE. Effect of the selective estrogen receptor modulator raloxifene on explanted uterine growth in rats. Drug Dev Res. 1995;36:43–5. P. Fanning, T. J. Kuehl, R. Lee et al., Video mapping to assess efficacy of an antiestrogen (raloxifene) on spontaneous endometriosis in the rhesus monkey, Macaca mulatta. In TJ Kuehl, editor. Bunkley Day Proceedings. 1996; pp. 51–6. Stratton P, Sinaii N, Segars J, et al. Return of chronic pelvic pain from endometriosis after raloxifene treatment: a randomized controlled trial. Obstet Gynecol. 2008;111:88–96. Meresman GF, Bilotas M, Abello V, Buquet R, Tesone M, Sueldo C. Effects of aromatase inhibitors on proliferation and apoptosis in eutopic endometrial cell cultures from patients with endometriosis. Fertil Steril. 2005;84:459–63. Velasco I, Rueda J, Acién P. Aromatase expression in endometriotic tissues and cell cultures of patients with endometriosis. Mol Hum Reprod. 2006;12:377–81. Pavone ME, Bulun SE. Aromatase inhibitors for the treatment of endometriosis. Fertil Steril. 2012;98:1370–9. Amsterdam LL, Gentry W, Jobanputra S, Wolf M, Rubin SD, Bulun SE. Anastrazole and oral contraceptives: a novel treatment for endometriosis. Fertil Steril. 2005;84:300–4. Remorgida V, Abbamonte HL, Ragni N, Fulcheri E, Ferrero S. Letrozole and norethisterone acetate in rectovaginal endometriosis. Fertil Steril. 2007;88:724–6. Ferrero S, Camerini G, Seracchioli R, Ragni N, Venturini PL, Remorgida V. Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. Hum Reprod. 2009;24:3033–41. Lu D, Song H, Shi G. Anti-TNF-α treatment for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2013;3:CD008088. Becker CM, Sampson DA, Short SM, Javaherian K, Folkman J, D’Amato RJ. Short synthetic endostatin peptides inhibit endothelial migration in vitro and endometriosis in a mouse model. Fertil Steril. 2006;85:71–7. Jiang HQ, Li YL, Zou J. Effect of recombinant human endostatin on endometriosis in mice. Chin Med J. 2007;120:1241–6. Dabrosin C, Gyorffy S, Margetts P, Ross C, Gauldie J. Therapeutic effect of angiostatin gene transfer in a murine model of endometriosis. Am J Pathol. 2002;161:909–18. Oktem M, Esinler I, Eroglu D, Haberal N, Bayraktar N, Zeyneloglu HB. High- dose atorvastatin causes regression of endometriotic implants: a rat model. Hum Reprod. 2007;22:1474–80. Esfandiari N, Khazaei M, Ai J, Bielecki R, Gotlieb L, Ryan E, et al. Effect of a statin on an in vitro model of endometriosis. Fertil Steril. 2007;87:257–62. Sharma I, Dhawan V, Mahajan N, Saha SC, Dhaliwal LK. In vitro effects of atorvastatin on lipopolysaccharide-induced gene expression in endometriotic stromal cells. Fertil Steril. 2010;94:1639–46.e1. Novella-Maestre E, Carda C, Ruiz-Sauri A, Garcia-Velasco JA, Simon C, Pellicer A. Identification and quantification of dopamine receptor 2 inhuman eutopic and ectopic endometrium: a novel molecular target for endometriosis therapy. Biol Reprod. 2010;83:866–73. Delgado-Rosas F, Gomez R, Ferrero H, Gaytan F, Garcia-Velasco J, Simon C, et al. The effects of ergot and non-ergot-derived dopamine agonists in an experimental mouse model of endometriosis. Reproduction. 2011;142:745–55. Ercan CM, Kayaalp O, Cengiz M, Keskin U, Yumusak N, Aydogan U, et al. Comparison of efficacy of bromocriptine and cabergoline to GnRH agonist in a rat endometriosis model. Arch Gynecol Obstet. 2015;291:1103–11. Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;(3):CD003678. Kennedy S, Bergqvist A, Chapron C, et al; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20:2698–704. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70:1176–80. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82:1633–7. Carmona F, Martínez-Zamora MA, Rabanal A, Martínez-Román S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril. 2011;96:251–4. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16:CD004992. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta- analysis. J Clin Endocrinol Metab. 2012;97:3146–54. Pados G, Tsolakidis D, Assimakopoulos E, Athanatos D, Tarlatzis B. Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study. Hum Reprod. 2010;25:672–7. Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94:71–7. Muzii L, Panici PB. Combined technique of excision and ablation for the surgical treatment of ovarian endometriomas: the way for- ward? Reprod Biomed Online. 2010;20(2):300–2. Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertil Steril. 2010;94:28–32. Muzii L, Achilli C, Bergamini V, et al. Comparison between the stripping technique and the combined excisional/ablative technique for the treatment of bilateral ovarian endometriomas: a multicentre RCT. Hum Reprod. 2016;31:339–44. Mircea O, Puscasiu L, Resch B, Lucas J, Collinet P, von Theobald P, Merviel P, Roman H. Fertility outcomes after ablation using plasma energy versus cystectomy in infertile women with ovarian endometrioma: a multicentric comparative study. J Minim Invasive Gynecol. 2016;23:1138–45. Motte I, Roman H, Clavier B, Jumeau F, Chanavaz-Lacheray I, Letailleur M, Darwish B, Rives N. In vitro fertilization outcomes after ablation of endometriomas using plasma energy: a retrospective case-control study. Gynecol Obstet Fertil. 2016;44:541–7. Roman H, Auber M, Mokdad C, et al. Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive. Fertil Steril. 2011;96:1396–400. Angioli R, Muzii L, Montera R, et al. Feasibility of the use of novel matrix hemostatic sealant (FloSeal) to achieve hemostasis during laparoscopic excision of endometrioma. J Minim Invasive Gynecol. 2009;16:153–6. Ghafarnejad M, Akrami M, Davari-Tanha F, Adabi K, Nekuie S. Vasopressin effect on operation time and frequency of electro- cauterization during laparoscopic stripping of ovarian endometriomas: a randomized controlled clinical trial. J Reprod Infertil. 2014;15:199–204. Muzii L, Marana R, Angioli R, et al. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter? Fertil Steril. 2011;95:2116–9. Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol. 2010;17:600–4. Yohannes P. Ureteral endometriosis. J Urol. 2003;170:20–5. Berlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L. Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv. 2009;64:830–42. Maccagnano C, Pellucchi F, Rocchini L, et al. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int. 2012;89:249–58. Schneider A, Touloupidis S, Papatsoris AG, Triantafyllidis A, Kollias A, Schweppe KW. Endometriosis of the urinary tract in women of reproductive age. Int J Urol. 2006;13:902–4. Vercellini P, Pisacreta A, Pesole A, Vicentini S, Stellato G, Crosignani PG. Is ureteral endometriosis an asymmetric disease? BJOG. 2000;107:559–61. Scioscia M, Molon A, Grosso G, Minelli L. Laparoscopic management of ureteral endometriosis. Curr Opin Obstet Gynecol. 2009;21:325–8. Ghezzi F, Cromi A, Bergamini V, Serati M, Sacco A, Mueller MD. Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil Steril. 2006;86:418–22. Mereu L, Gagliardi ML, Clarizia R, Mainardi P, Landi S, Minelli L. Laparoscopic management of ureteral endometriosis in case of moderate–severe hydroureteronephrosis. Fertil Steril. 2010;93:46–51. Smith IA, Cooper M. Management of ureteric endometriosis 59 associated with hydronephrosis: an Australian case series of 13 patients. BMC Res Notes. 2010;3:45. Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical 60 implications and proposition for a classification. Hum Reprod. 2003;18:157–61. Mmm Kondo W, Bourdel N, Tamburro S, et al. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2011;118:292–8. Azaïs H, Collinet P, Delmas V, Rubod C. Uterosacral ligament and hypogastric nerve anatomical relationship. Application to deep endometriotic nodules surgery. Gynecol Obstet Fertil. 2013;41:179–83. Campagnacci R, Perretta S, Guerrieri M, et al. Laparoscopic colorectal resection for endometriosis. Surg Endosc. 2005;19:662–4. Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod. 2010;25:1949–58. Fanfani F, Fagotti A, Gagliardi ML, et al. Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case–control study. Fertil Steril. 2010;94:444–9. Oliveira MA, Crispi CP, Oliveira FM, Junior PS, Raymundo TS, Pereira TD. Double circular stapler technique for bowel resection in rectosigmoid endometriosis. J Minim Invasive Gynecol. 2014;21:136–41. Koh CE, Juszczyk K, Cooper MJ, Solomon MJ. Management of deeply infiltrating endometriosis involving the rectum. Dis Colon Rectum. 2012;55:925–31. Moawad NS, Guido R, Ramanathan R, Mansuria S, Lee T. Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis. JSLS. 2011;15:331–8. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98:564–71. Wattiez A, Puga M, Albornoz J, Faller E. Surgical strategy in endometriosis. Best Pract Res Clin Obstet Gynaecol. 2013;27:381–92. Kavallaris A, Banz C, Chalvatzas N, et al. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients’ outcome. Arch Gynecol Obstet. 2011;284:131–5. Keckstein J, Wiesinger H. Deep endometriosis, including intestinal involvement – the interdisciplinary approach. Minim Invasive Ther Allied Technol. 2005;14:160–6. Leroy J, Costantino F, Cahill RA, et al. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg. 2011;98:1327–34. Moustafa MM, Elnasharty MAA. Systematic review of the outcome associated with different surgical technique of bowel and rectovaginal endometriosis. Gynaecol Surg. 2014;11:37–52. Koninckx P, Craessaerts M, Timmerman D, Cornillie F, Kennedy S. Anti- TNF-a treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial. Hum Reprod. 2008;23:2017–23. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2018 Springer International Publishing AG, part of Springer Nature About this chapter Cite this chapter Zupi, E., Lazzeri, L., Exacoustos, C. (2018). Medical and Surgical Management of Endometriosis. In: Guerriero, S., Condous, G., Alcázar, J.L. (eds) How to Perform Ultrasonography in Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-319-71138-6_2 Download citation DOI: https://doi.org/10.1007/978-3-319-71138-6_2 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-71137-9 Online ISBN: 978-3-319-71138-6 eBook Packages: MedicineMedicine (R0)

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (1)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
unpaywall
last seen: 2026-08-26T06:23:03.089193+00:00
License: CC0 · commercial use OK