Endometriosis and infertility: an aggressive surgical approach.

A review of 2 series of endometriosis patients under 31-years-old 56 from 1942 to 1961 and 86 form 1962-1974 with a discussion of the authors preference for agressive surgery for this disorder is presented. The most common symptoms were pelvic or rectal pain dysmenorrhea dyspareunia (30-40%) hypermenorrha (20%) infertility (60%) and secondary infertility (30%) Surgical procedures were intensified in Group 2 e.g. numbers of endometriomal resections ovarian resections presacral neurectomies and bowel resections were increased in the more recnt series. Oophorectomy was performed in those with over 80% of an ovary involved. It is emphasized that both involved surfaces should be excised in case of adhesions. In these groups 65-75% of complaints were relieved 66 and 70% of those desiring pregnancy conceived although 27% of the 2nd series aborted. Only about 50% of the patients whose uterus was suspended conceived. Similarly presacral neurectomy did not improve pregnancy rates. Recurrent endometrosiss was equally frequent. The following are recommended: examining young women for endometriosis encouraging early pregnancy in case of a diagnosis excising lesions especially in ovarian intestinal or colonic involvement and early surgery rather than hormone treatment.