Treatment strategies for deep infiltrating endometriosis at posterior part of the pelvis

Deep infiltrating endometriosis (DIE) is defined as endometriosis lesions penetrating into retroperitoneal space for a distance of 5 mm or more. Most of DIE lesions are located at posterior part of the pelvis,which usually manifest as thickening,shortening or nodules of utero-sacral ligaments,nodules of cul-de sac orrecto-vaginal space with or without the obliteration of cul-de sac. DIE is responsible for painful symptoms including dysmenorrhea,chronic pelvic pain (CPP) or dyspareunia. Surgical resection is the primary treatment and higher pain relief rate are associated with complete resection. Postoperative medical treatment may delay recurrence.