Treatment of deeply infiltrating endometriosis

Koninckx PR, Philippe R. Koninckx, P R Koninckx, Dan C. Martin, D Martin
Current opinion in obstetrics & gynecology · 1994 · vol. 6(3) , pp. 231–241 · doi:10.1097/00001703-199406000-00006 · PMID:8038409 · W2019264491
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This paper presents a model for endometriosis development, differentiates deep and ovarian endometriosis, discusses diagnosis and potential causes like dioxin pollution, and outlines surgical excision as the preferred treatment due to high pregnancy and cure rates.

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This paper defines deeply infiltrating endometriosis as lesions extending more than five millimeters beneath the peritoneum and proposes that such severe disease affects approximately twenty percent of women. The authors argue for classifying deep infiltration and cystic ovarian endometriosis as distinct entities, noting that diagnosis relies on clinical examination, menstrual timing, and CA-125 levels. Surgical excision is identified as the preferred treatment due to high pregnancy rates and effective pain relief, while medical therapies like GnRH agonists are considered less effective for infertility but useful for symptom management or preoperative preparation. This paper is centrally about endometriosis — specifically the definition, diagnosis, and surgical management of deeply infiltrating lesions.

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Abstract

Deep endometriosis has been defined as endometriosis infiltrating deeper than 5 mm under the peritoneum. A model for the development and propagation of endometriosis is presented. Subtle and non-pigmented lesions are suggested to occur intermittently in all women. Infiltration occurs generally to a few millimeters of depth only, and these lesions become typical, burnt out lesions. In some 20% of women, severe endometriosis develops either as deeply infiltrating disease or as cystic ovarian disease. Arguments are given to consider deep endometriosis and cystic ovarian endometriosis as two specific entities of endometriotic disease. A possible causal relationship with dioxin pollution is discussed. Diagnosis of deep endometriosis is made by clinical examination and palpation during surgery. Clinical examination during menstruation and CA-125 concentrations in plasma are useful to help in the diagnosis of smaller deep lesions. Surgical excision can be carried out by laparoscopy, laparotomy or vaginally using sharp dissection, electrosurgery or with the use of a CO2 laser. Excision is the treatment of choice because of a high pregnancy rate, a complete cure of pain in most women, and a low recurrence rate. Medical treatment is probably less effective to treat infertility, but highly effective in relieving pelvic pain. Medical therapy, by luteinizing hormone-releasing hormone agonists, danazol, or gestrinone, also seems useful as a pretreatment for surgery. The choice of treatment will therefore depend on the local expertise with minimal invasive surgery, certainly if a first excision has been incomplete and pain symptoms recur.
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Treatment of deeply infiltrating endometriosis - Philippe R. Koninckx - Dan Martin Deep endometriosis has been defined as endometriosis infiltrating deeper than 5 mm under the peritoneum. A model for the development and propagation of endometriosis is presented. Subtle and non-pigmented lesions are suggested to occur intermittently in all women. Infiltration occurs generally to a few millimeters of depth only, and these lesions become typical, burnt out lesions. In some 20% of women, severe endometriosis develops either as deeply infiltrating disease or as cystic ovarian disease. Arguments are given to consider deep endometriosis and cystic ovarian endometriosis as two specific entities of endometriotic disease. A possible causal relationship with dioxin pollution is discussed. Diagnosis of deep endometriosis is made by clinical examination and palpation during surgery. Clinical examination during menstruation and CA-125 concentrations in plasma are useful to help in the diagnosis of smaller deep lesions. Surgical excision can be carried out by laparoscopy, laparotomy or vaginally using sharp dissection, electrosurgery or with the use of a CO2 laser. Excision is the treatment of choice because of a high pregnancy rate, a complete cure of pain in most women, and a low recurrence rate. Medical treatment is probably less effective to treat infertility, but highly effective in relieving pelvic pain. Medical therapy, by luteinizing hormone-releasing hormone agonists, danazol, or gestrinone, also seems useful as a pretreatment for surgery. The choice of treatment will therefore depend on the local expertise with minimal invasive surgery, certainly if a first excision has been incomplete and pain symptoms recur.

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Female Fertility Humans Ovarian Cysts Ovarian Cysts Ovarian Cysts Ovarian Cysts Ovarian Diseases Ovarian Diseases Ovarian Diseases Ovarian Diseases Pelvic Pain Pelvic Pain Pelvic Pain Peritoneum Peritoneum

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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.

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