s Surgical Treatment of Endometriosis

Objective: We review the surgical modalities used in the treatment of endometriosis, including ablative, excisional and denervating. Design: A systematic review of the literature referring to the surgical treatment of endometriosis with emphasis on articles published since 2000. Data sources: Medline, MeSH and Cochrane library searches for terms including “endometriosis”, “ablation”, “excision”, “denervation”, “pelvic pain” and “infertility”. Eligibility criteria: Trials assessing the short, medium and longer-term efficacy of surgical modalities employed in the treatment of endometriosis were considered. Studies published prior to 2000 and small power trials were included only if commonly referenced in the literature. Results: 114 articles were considered with 53 referenced in the final review. Conclusions: Excisional treatment provides more favourable outcomes than drainage and ablation with regards to pain relief, endometrioma recurrence, symptom control and fertility rates. Ancillary surgical procedures such as presacral neurectomy and laparoscopic uterine nerve ablation can prove helpful in the management of dysmenorrhoea. Radical surgery in the form of hysterectomy remains end-stage treatment for endometriosis. The role of medical treatment remains unclear.