Die operative Therapie der Endometriose

Kernaussagen

Zur Behandlung der Endometriose stehen verschiedene Maßnahmen zur Verfügung wie die endokrine, die symptomatische und die operative Therapie einzeln oder in Kombination. Die individuelle Situation der Patientin gilt es immer zu berücksichtigen. Vor Planung einer operativen Sanierung steht eine umfassende Diagnostik, um eine mögliche Untertherapie oder Übertherapie der zu Rezidiven neigenden Erkrankung zu vermeiden und um das Ausmaß der Endometriose vor den häufig komplexen Eingriffen zu erfassen.

Bei Verdacht auf Endometriose sollte zur Diagnosesicherung die diagnostische Laparoskopie durchgeführt werden (Goldstandard) und gegebenenfalls zur sanierenden Operation erweitert werden. Ziel ist die Resektion in sano, die auch in fortgeschrittenen Stadien und bei tief infiltrierender Endometriose unter Einbeziehung anderer Fachrichtungen (Urologie, Chirurgie) sehr häufig laparoskopisch möglich ist. Für die unterschiedlich eingesetzten Techniken bei tief infiltrierender Endometriose liegen keine belastbaren Evidenzen vor. Neben der Operation spielt die medikamentöse Therapie eine nicht minder wichtige Rolle zur Vermeidung von Rezidiven und zur Symptomkontrolle.

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