Surgical Therapy of Endometriosis: Challenges and Controversies

Abstract

Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.

Zusammenfassung

Die Endometriose gehört zu den häufigsten Krankheitsbildern in der operativen Gynäkologie mit erheblichen Herausforderungen an die laparoskopische Technik, aber auch die OP-Planung, Patientinnenaufklärung und Interdisziplinarität. Ziel im Hinblick auf eine bestmögliche Symptomkontrolle ist die vollständige Entfernung der erkennbaren Krankheitsherde, die aber limitiert wird durch nachweisliche Grenzen der Detektierbarkeit und die Risiken radikaler Operationsstrategien. So kann die Exzision ovarieller Endometriome zu einer signifikanten Beeinträchtigung der Ovarialfunktion, die Läsion nervaler Strukturen bei der Resektion tief-infiltrierender Endometriose der Sakrouterinligamente, der Parametrien, des Septum rectovaginale und des Vaginalpols zu schwerwiegenden Funtionsbeeinträchtigungen wie Blasenentleerungsstörungen führen. Eine gründliche Nutzen-Risiko-Abwägung muss daher symptomorientiert erfolgen und in einem individualisierten Vorgehen resultieren.

Key words

reproductive medicine - dyspareunia - endometriosis - gynaecology - infertility - ovary

Schlüsselwörter

Reproduktionsmedizin - Dyspareunie - Endometriose - Gynäkologie - Infertilität - Ovar

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