Modern approaches to surgical and postsurgical medical management of patients with endometriosis

Modern approaches to surgical and postsurgical medical management of patients with endometriosis DOI: https://doi.org/10.18370/2309-4117.2017.34.8-14Keywords: endometriosis, infertility, surgical methods, hormonal therapy, secondary preventionAbstract December 8, 2016 in Kyiv Advisory Board was held related to modern approaches to surgical and postsurgical medical management of patients with endometriosis. Endometriosis is a chronic estrogen-dependent gynecological disease which requires a life-long management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures. The disease management tactics in patients with endometriosis are determined by the clinical symptoms and includes observation, medical treatment, surgical treatment (conservative, radical), using of the assisted reproductive technologies. To prevent endometriosis recurrence it is reasonable to use a combined approach – surgical methods and hormonal therapy. In resolution surgical tactics of management of patients with endometriosis is described in detail based on clinical symptoms and appropriate conditions for this intervention, according to the unified clinical protocol “Management of patients with genital endometriosis” approved by Order of Ministry of Health of Ukraine No. 319 dated April 06, 2016. Postsurgical prevention of endometriosis recurrence is an important stage of management of patients with endometriosis, as regardless of the proven efficacy of the surgical treatment, a risk of endometriosis lesions and pain recurrence is exist. As noted in the resolution, currently no clear criteria for endometriosis recurrence evaluation are available. The hormonal therapy may maintain the positive effect of the surgical treatment for a long time and may minimize the risk of pain and endometrioid lesions recurrence. For secondary prevention of endometriosis recurrence and associated pain long-term hormonal therapy is recommended (> 6 months). A surgeon plays a key role in prescription of postsurgical medical treatment: he/she determines its strategy for the first 6 months after the surgery in alignment with the outpatient physician. To treat the women with endometriosis and infertility, the surgeon should have the appropriate skills and experience. Cooperation with the centers of reproductive medicine is also mandatory. In persistent infertility (failure of long-term therapy) of non-defined origin and suspected endometriosis (presence of pain syndrome), it is reasonable to perform the laparoscopy to rule out the endometriosis as a cause of infertility and its surgical treatment. After surgery, the patients with the reproductive plans are recommended to prescribe dienogest for 3 months and in case of infiltrating endometriosis forms – at least for 6 months to minimize the inflammatory process. As its noted in resolution medical and surgical methods of endometriosis treatment should not be considered as competitive but as compatible, which increase the treatment efficacy and improve the disease prognosis. References - Management of patients with endometriosis. 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