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Surgical management of endometriosis

^1. Isle of Wight NHS Primary Care Trust, St Mary's Hospital, Parkhurst Road, Newport, Isle of Wight PO30 5TG, UK Email: Nicholas.Kenney{at}iow.nhs.uk (corresponding author)
^2. Worthing and Southlands Hospital NHS Trust, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK

Key content:

• Advances in laparoscopic surgery have made the surgical management of endometriosis an effective treatment that offers advantages over medical therapy.
  
• The majority of gynaecologists readily perform laparoscopic ablation of superficial disease. Excision of deeper disease and management of rectovaginal disease require more expertise and should be managed in tertiary centres.
  
• Hysterectomy should not be necessary in the majority of cases. Although some women may benefit, extrauterine disease should also be excised.
  
• Evidence suggests that laparoscopic uterine nerve ablation (LUNA) has no effect on long-term symptoms.
  
• There is no consensus as to the optimal surgical approach for rectal disease. A multicentre, randomised controlled trial is urgently required to resolve the issue.
  

Learning objectives:

• To understand the role of surgery in the management of endometriosis.
  
• To be aware of the best available evidence so that the optimal approach can be used when performing surgery.
  
• To be aware of the preoperative care of women with advanced disease and when to refer them for further management.
  

Ethical issues:

• What should be regarded as an acceptable complication rate for women undergoing surgery for advanced endometriosis?
  
• What level of training should gynaecologists reach if they are to be judged competent in the surgical management of endometriosis?
  
• Given that the surgical management of endometriosis is a developing skill, where is the boundary between accepted and acceptable practice?
  

Please cite this article as: Kenney N, English J. Surgical management of endometriosis. The Obstetrician & Gynaecologist 2007;9:147–152.

Keywords endometrioma / endometriosis / pelvic denervation / peritoneal disease / rectovaginal disease / surgery