Endometriosis: radical surgery

Radical ablative surgery for endometriosis is indicated chiefly for symptoms of pain that fail to respond to conservative treatment. The sites of involvement must be carefully assessed and surgery planned taking account of the wishes of the patient concerning her fertility. Procedures include oophorectomy, salpingo-oophorectomy, hysterectomy, appendicectomy, and the excision of deeply infiltrating endometriosis possibly involving bowel resection. The most important arbiter of therapeutic success is the removal of the ovaries, hysterectomy and bilateral salpingo-oophorectomy offering the ultimate cure for this chronic condition. Whereas laparotomy has been the traditional approach for most of these procedures, vaginal and laparoscopic surgery are modern alternatives for many of these cases offering important advantages in terms of reduced postoperative discomfort, shorter hospitalization, faster recovery and a superior cosmetic result. Preoperative and postoperative medical therapy has a limited role in surgery, whereas postoperative hormone replacement therapy after bilateral oophorectomy is generally recommended.