Endometriosis

Explorative laparoscopy in patients with infertility to exclude endometriosis has become standard care. Transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid has a very good diagnostic performance, with a sensitivity and specificity of over 95%. Medical treatment targets the oestrogen-dependent character of the disease. Gonadotropin releasing hormone analogues and aromatase inhibitors induce a state of hypo-oestrogenism and endometriois suppression. Segmental excision of the rectum for endometriosis is fundamentally different from rectal excision for cancer. Once the dissection extends below the endometriosis, the pelvic tissues are generally healthy, unlike those found in elderly patients or after radiotherapy for cancer. Van den Broeck et al. studied the effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning. Other groups demonstrated an improvement of quality of sex life after laparoscopic resection for deep infiltrating endometriosis. Surgery for deep infiltrating endometriosis should be performed in centres of expertise for fertility surgery.