Endometriosis

J. Benjamin Younger
In: Current Opinion in Obstetrics and Gynecology · 1993 · vol. 5(3) , pp. 333???339 · doi:10.1097/00001703-199306000-00008 · W4240625211
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Endoscopic surgery is replacing laparotomy for endometriosis treatment with similar outcomes but lower costs, and medical suppression and nerve ablation offer limited additional benefit.

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This review examines the evolving surgical management of endometriosis, highlighting a shift from laparotomy to endoscopic techniques due to comparable clinical outcomes and lower costs. It notes that complete surgical destruction is often sufficient, rendering medical suppressive therapy largely unnecessary for most patients with minimal or mild disease. The text also advises against the routine addition of presacral neurectomy or uterine nerve ablation, citing limited evidence for their benefit in preventing recurrence. This paper is centrally about endometriosis — specifically discussing the efficacy and cost-effectiveness of laparoscopic treatment strategies compared to open surgery.

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Abstract

The surgical approach to treatment of endometriosis is shifting away from laparotomy toward endoscopy as technology and experience improve. All patients with minimal or mild disease and a significant portion of those with advanced disease can be treated endoscopically with little difference in clinical outcome but a significant difference in cost. The various lasers as well as sharp dissection and bipolar cautery are adequate tools for this approach. With complete surgical destruction, medical suppressive therapy adds little therapeutic benefit. There is little evidence to suggest that laparoscopic presacral neurectomy or uterine nerve ablation should be routinely added. Long-term recurrence of disease is probably less than 25%. It is likely that the American Fertility Society classification will be revised to adapt to our changing knowledge and treatment strategy.
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Endometriosis - J. Benjamin Younger The surgical approach to treatment of endometriosis is shifting away from laparotomy toward endoscopy as technology and experience improve. All patients with minimal or mild disease and a significant portion of those with advanced disease can be treated endoscopically with little difference in clinical outcome but a significant difference in cost. The various lasers as well as sharp dissection and bipolar cautery are adequate tools for this approach. With complete surgical destruction, medical suppressive therapy adds little therapeutic benefit. There is little evidence to suggest that laparoscopic presacral neurectomy or uterine nerve ablation should be routinely added. Long-term recurrence of disease is probably less than 25%. It is likely that the American Fertility Society classification will be revised to adapt to our changing knowledge and treatment strategy.

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endometriosis

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