Semin Reprod Med 2017; 35(01): 054-064
DOI: 10.1055/s-0036-1597306
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Management of Endometriosis in Patients with Chronic Pelvic Pain

Rebecca Flyckt
1  Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Beachwood Family Health Center, Beachwood, Ohio
,
Suejin Kim
2  Department of Obstetrics and Gynecology, Cleveland Clinic Main Campus, Cleveland, Ohio
,
Tommaso Falcone
3  Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cleveland Clinic Main Campus, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2017 (eFirst)

Abstract

Surgical approaches to endometriosis patients with chronic pelvic pain are multimodal and require individualization. Laparoscopic approaches are preferred over laparotomy when conservatively treating endometriosis via excision or ablation/fulguration of lesions. The available data support cystectomy over fenestration or fulguration for endometriomas; however, there may be associated decreases in ovarian reserve with endometrioma treatment. Presacral neurectomy may be useful in patients with midline pain and LUNA is not effective for the treatment of pelvic pain related to endometriosis. Appendectomy may be considered prophylactically at the time of the surgery for pelvic pain, although more studies are needed. For deep infiltrating endometriosis, the risks of aggressive bowel surgery must be weighed against the benefits of clear pain reduction. Postoperative medical suppressive therapy is strongly recommended to prolong symptom-free intervals of this chronic disease. As definitive therapy, hysterectomy can be helpful especially when combined with endometriosis excision. When performing hysterectomy, bilateral oophorectomy should be given careful consideration, as this procedure leads to premature surgical menopause and may not decrease the possibility of reoperation and persistence of symptoms in patients aged 30 to 39 years with chronic pain.