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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.

    Summary

    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

     

    References

    1. Adamson GD, et al. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J Endometriosis. 2010;2(1):3–6.

    2. Johnson N, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013;28(6):1552–1568.

    3. Yeung P Jr. The laparoscopic management of endometriosis in patients with pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):371–383.

    4. Albee RB Jr., Sinervo K, Fisher D. Laparoscopic excision of lesions suggestive of endometriosis or otherwise atypical in appearance: relationship between visual findings and final histologic diagnosis. J Minim Invasive Gynecol. 2008;15(1):32–37.

    5. Roman JD. Surgical treatment of endometriosis in private practice: cohort study with mean follow-up of 3 years. J Minim Invasive Gynecol. 2010;17(1):42–46.

    6. Kristensen J, Kjer JJ. Laparoscopic laser resection of rectovaginal pouch and rectovaginal septum endometriosis: the impact on pelvic pain and quality of life. Acta Obstet Gynecol Scand. 2007;86(12):1467–1471.

    7. Rimbach , Ulrich U, Schweppe KW. Surgical therapy of endometriosis: challenges & controversies. Geburtshilfe Frauenheilkd. 2013;73(9):918–923.

    8. Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 2011;95(6):1909–1912, 1912.e1.

    9. Jones KD, Sutton C. Endometriosis. Emphasis on medical treatment is misleading. BMJ. 2002;324(7329):115.

    10. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15(4):261–267.

    11. Rodgers AK, Falcone T. Treatment strategies for endometriosis. Expert Opin Pharmacother. 2008;9(2):243–255.

    12. Healey M, Cheng C, Kaur H. To excise or ablate endometriosis? A prospective randomized double-blinded trial after 5-year follow-up. J Minim Invasive Gynecol. 2014;21(6):999–1004.

    13. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update. 2009;15:177–188.

    14. Rizk B, Fischer AS, Lotfy HA, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014;6(4):219–227.

    15. Selcuk I, Bozdag G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc. 2013;14(2):98–103.

    16. Giudice L, Evers J, Healy DL. Endometriosis: Science & Practice. Chichester, West Sussex: Wiley-Blackwell, 2012.

    17. Shah P, Adlakha A. Laparoscopic management of moderate: Severe endometriosis. J Minim Access Surg. 2014;10(1):27–33.

    18. Miranda-Mendoza I, Kovoor E, Nassif J, Ferreira H, Wattiez A. Laparoscopic surgery for severe ureteric endometriosis. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):275–279.

    19. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2014.

    20. Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–597.

    21. Brown J, Farquhar C. An overview of treatments for endometriosis. JAMA. 2015;313(3):296–297.

    22. Muzii L, Miller CE. The singer, not the song. J Minim Invasive Gynecol. 2011;18(5):666–667.

    23. Koga K, Takemura Y, Osuga Y, et al. Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod. 2006;21(8):2171–2174.

    24. Lind T, Hamarstrom M, Lampic C, Rodriguez-Wallberg K. Anti-Müllerian hormone reduction after ovarian cyst surgery is dependent on the histological cyst type and preoperative anti-Müllerian hormone levels. Acta Obs Gyne Scan. 2015;94(2):183–190.

    25. Fritzer N, Tammaa A, Salzer H, Hudelist G. Effects of surgical excision of endometriosis regarding quality of life and psychological well-being: a review. Womens Health (Lond Engl). 2012;8(4):427–435.

    26. Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand. 2012;91(6):692–698.

    27. Bachmann R, Bachmann C, Lange J, et al. Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting. Arch Gynecol Obstet. 2014;290(5):919–924.

    28. Angioni S, Pontis A, Dessole M, Surico D, De Cicco Nardone C, Melis I. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRH-A administration after surgery. Arch Gynecol Obstet. 2015;291(2):363–370.

    29. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261–275.

    30. D'Hooghe T, et al. The costs of endometriosis: it's the economy, stupid. Fertil Steril. 2012;98(3):S218–S219.

    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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