Endometriosis: surgical approaches to stages I and II

D. Mavrelos, Ertan Sarıdoğan
In: Chronic Pelvic Pain · 2014 · pp. 60–70 · doi:10.1017/cbo9781107478084.006 · W2478259931
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⚙ AI-generated summary by claude@2026-06, 2026-06-14 ⓘ

This review discusses the surgical approaches for stages I and II endometriosis, noting limitations of the ASRM classification regarding clinical correlation and treatment decisions for seemingly mild disease.

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This chapter in the book Chronic Pelvic Pain surveys the spectrum of chronic pelvic pain and related pelvic anatomy/neuroanatomy, outlines investigation approaches such as ultrasound, and then focuses on surgical approaches specifically for endometriosis stages I and II. It describes how surgical management fits within a broader framework that also includes medical treatments, psychological considerations, and evaluation of other pelvic pain conditions (e.g., vulvodynia and bladder pain syndrome). A key limitation is that the provided text is only a content preview without the chapter’s actual evidence or outcome data, so specific comparative findings cannot be verified here. This paper is centrally about endometriosis — it has a dedicated chapter section on surgical approaches for stages I and II.

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Abstract

© Cambridge University Press 2015. Introduction The most commonly used staging system for endometriosis is the revised American Society for Reproductive Medicine (ASRM) classification [1]. This requires calculation of a score based on the size of the endometriotic lesions, the depth of tissue involvement, and the presence and extent of adhesions around the fallopian tubes and ovaries as well as degree of pouch of Douglas (posterior cul-de-sac) obliteration. Patients are classified into one of four stages depending on the severity of disease: I (minimal), 1–5 points II (mild), 6–15 points III (moderate), 16–40 points IV (severe), >40 points. Stages I and II disease exclude any women with endometriomas larger than 1cm and complete cul-de-sac obliteration. Stage I endometriosis usually affects the peritoneum superficially, with filmy adhesions that enclose one-third or less of the tubes or ovaries. Stage II is more advanced disease with more extensive superficial peritoneal lesions and filmy adhesions around the fallopian tubes and ovaries. In stage II, the adhesions may be denser and enclose up to two-thirds of the ovary. Stage II endometriosis may also include the presence of a small endometrioma ≤1cm in diameter in the ovary. The ASRM classification puts the deeply infiltrating endometriosis without cul-de-sac obliteration, endometriomas, and significant peritubo-ovarian adhesions into the mild endometriosis category. However, this type of endometriosis may have wider clinical implications on symptomatology and its surgical treatment tends to be more challenging. The ASRM classification is based on the morphological appearance at the time of surgery and the terms “minimal” and “mild” do not correlate with the clinical impact of the disease. So, despite the seemingly mild presentation, early-stage disease is not innocuous and can be associated with significant pain and impaired fertility. Moreover advancing morphological stage of endometriosis does not correlate well with deteriorating symptoms. So it is possible for surgeons to come across minimal or mild endometriosis in women without any clinical symptoms. Surgeons then find themselves in a dilemma over whether they should treat or not.
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- Chronic Pelvic Pain - Chronic Pelvic Pain - Copyright page - Contents - Contributors - 1 Chronic pelvic pain: spectrum of the disorder - 2 Pelvic anatomy and neuroanatomy: relevance to chronic pelvic pain - 3 Investigating chronic pelvic pain: ultrasound - 4 Investigating chronic pelvic pain: surgical approaches - 5 Medical treatments for endometriosis-related pain - 6 Endometriosis: surgical approaches to stages I and II - 7 Endometriosis: surgical approaches to stages III and IV - 8 Psychological considerations and therapies in patients with chronic pelvic pain - 9 Vulvodynia - 10 Interstitial cystitis/bladder pain syndrome - 11 Pelvic inflammatory disease and chronic pelvic pain - 12 Chronic pelvic pain and sexual dysfunction: cause and effect - 13 Complementary therapies for women with chronic pelvic pain - 14 Management of idiopathic chronic pelvic pain - Index Published online by Cambridge University Press: 18 December 2014 Book contents - Chronic Pelvic Pain - Chronic Pelvic Pain - Copyright page - Contents - Contributors - 1 Chronic pelvic pain: spectrum of the disorder - 2 Pelvic anatomy and neuroanatomy: relevance to chronic pelvic pain - 3 Investigating chronic pelvic pain: ultrasound - 4 Investigating chronic pelvic pain: surgical approaches - 5 Medical treatments for endometriosis-related pain - 6 Endometriosis: surgical approaches to stages I and II - 7 Endometriosis: surgical approaches to stages III and IV - 8 Psychological considerations and therapies in patients with chronic pelvic pain - 9 Vulvodynia - 10 Interstitial cystitis/bladder pain syndrome - 11 Pelvic inflammatory disease and chronic pelvic pain - 12 Chronic pelvic pain and sexual dysfunction: cause and effect - 13 Complementary therapies for women with chronic pelvic pain - 14 Management of idiopathic chronic pelvic pain - Index A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content. - Type - Chapter - Information - Chronic Pelvic Pain , pp. 60 - 70Publisher: Cambridge University PressPrint publication year: 2014 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Endometriosis: surgical approaches to stages I and II - - Book: Chronic Pelvic Pain - Online publication: 18 December 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Endometriosis: surgical approaches to stages I and II - - Book: Chronic Pelvic Pain - Online publication: 18 December 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Endometriosis: surgical approaches to stages I and II - - Book: Chronic Pelvic Pain - Online publication: 18 December 2014

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endometriosisendometrioma

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