Laparoscopic Management of Endometriosis: Comprehensive Review of Best Evidence

P.P. Yeung, Yeung PP Jr, Patrick Peter Yeung, James Shwayder, Shwayder J, Resad P. Pasic, Pasic RP, Resad Pasic
Journal of Minimally Invasive Gynecology · 2009 · vol. 16(3) , pp. 269–281 · doi:10.1016/j.jmig.2009.02.007 · PMID:19423059 · W2078103370
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This paper provides a comprehensive review of the best evidence regarding the laparoscopic management of endometriosis, detailing current best practices and surgical techniques.

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Abstract

Study objectiveTo provide a comprehensive review of the best evidence available in the laparoscopic management of endometriosis for pain and/or fertility and to provide practical recommendations based on this information.DesignReview article of randomized controlled trials.PatientsWomen with endometriosis.MethodsA systematic search was performed of the Cochrane Library and MEDLINE database for randomized controlled trials relating only to laparoscopic management of endometriosis. The information from 7 Cochrane review articles and 35 original randomized trials is presented in a clinically relevant question-and-answer format.ConclusionsAwareness of endometriosis as a disease with substantial morbidity is vitally important. Laparoscopic treatment of endometriosis is beneficial for reducing pain and improving fertility. Laparoscopic presacral neurectomy, but not laparoscopic uterosacral nerve ablation, is a useful adjunct to conservative surgery for endometriosis in patients with a midline component of pain. Preoperative hormonal suppression with gonadotropin-receptor hormone analogue may be helpful in decreasing endometriosis disease scores. Postoperative hormonal suppression with either a gonadotropin-receptor hormone analogue or progestin (including the levonorgestrel intrauterine system) may be helpful in reducing pain and increasing time to recurrence of symptoms. Excisional cystectomy is the preferred method to treat endometrial cysts for both pain and fertility and may be aided by the use of mesna and initial circular excision. An absorbable adhesion barrier (Interceed), 4% icodextrin solution (Adept), and a viscoelastic gel (Oxiplex/AP, FzioMed, Inc., San Luis Obispd, CA; not available in the United States) are safe and effective products to help prevent adhesions in laparoscopic surgery to treat endometriosis.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Laparoscopy Pelvic Pain Chemotherapy, Adjuvant Endometriosis Endometriosis Endometriosis Female Humans Laparoscopy Pelvic Pain Pelvic Pain Pelvic Pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (86)

Cited by (50)

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License: CC0 · commercial use OK