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    The case for surgery for endometriosis


    Subsequently, many patients may benefit from early referral to an endometriosis center of expertise for careful clinical assessment and appropriate investigation in a timely manner.

    When properly removed through the excisional technique, endometriosis is far less likely to recur, fertility is preserved, and symptoms are reduced or even eliminated; no medical suppression is needed. When insufficiently treated through incomplete surgery and/or merely temporarily suppressed, however, progressive symptoms will likely continue,29 leading to additional and ongoing surgeries and medical therapies.


    Although all concerned with endometriosis will agree that early intervention and increased, accurate awareness are requisite to reduce morbidity, infertility, and progressive symptomatology, it is clear that failure to timely diagnose and treat has consequence for patients.

    We must strive to meet the challenges surrounding endometriosis and encourage improved health literacy, early intervention, and diagnosis combined with the gold standard: excisional treatment. Such an approach will not only improve quality of life for countless patients, but also reduce the significant healthcare costs associated with the disease: nearly $120 billion annually.30



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    Ken R Sinervo, MD, MSc, FRCSC, ACGE
    Dr Sinervo is Medical Director of the Center for Endometriosis Care, Atlanta, Georgia.

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    • Dr. CHOWE
      Thank you for an important article that reiterates the fact that the more endometriosis is removed surgically the better the results are for reduced recurrence, pain reduction and improved fertility. I would like to add this idea. In general it seems that endometriosis is not however "cured" with surgery. Post suppressive medical therapy in a premenopausal women who is not actively attempting to conceive is critical (especially when uterus and ovaries are left in place). It will result in a longer lasting effect. Otherwise, regardless of the extent of tissue (peritoneal implant) removal there will be recurrence in 2-5 years from either retrograde flow or peritoneal metaplasia. Without treatment you set a younger woman up to have multiple surgeries over the years. After multiple surgeries they can develop adhesive disease and neuropathic pain. This must be avoided. In my mind menopause is the only "cure" and everything else we do is only temporizing, regardless of how complete it is. Thank you again for your time and ideas! They are valuable.


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