Abstract
Surgical approaches to endometriosis patients with chronic pelvic pain are multimodal
and require individualization. Laparoscopic approaches are preferred over laparotomy
when conservatively treating endometriosis via excision or ablation/fulguration of
lesions. The available data support cystectomy over fenestration or fulguration for
endometriomas; however, there may be associated decreases in ovarian reserve with
endometrioma treatment. Presacral neurectomy may be useful in patients with midline
pain and LUNA is not effective for the treatment of pelvic pain related to endometriosis.
Appendectomy may be considered prophylactically at the time of the surgery for pelvic
pain, although more studies are needed. For deep infiltrating endometriosis, the risks
of aggressive bowel surgery must be weighed against the benefits of clear pain reduction.
Postoperative medical suppressive therapy is strongly recommended to prolong symptom-free
intervals of this chronic disease. As definitive therapy, hysterectomy can be helpful
especially when combined with endometriosis excision. When performing hysterectomy,
bilateral oophorectomy should be given careful consideration, as this procedure leads
to premature surgical menopause and may not decrease the possibility of reoperation
and persistence of symptoms in patients aged 30 to 39 years with chronic pain.
Keywords
endometriosis - surgical therapy - chronic pelvic pain
