Endometriosis affects women in two ways: it causes pelvic and abdominal pain, and it is associated with decreased fertility. Although symptoms such as pain and infertility may suggest the possible presence of endometriosis, the only definite way to diagnose it is by performing a laparoscopy.
Laparoscopy is a surgical procedure performed under general anesthesia that allows thorough visualization and inspection of all pelvic structures including: the uterus, ovaries, fallopian tubes as well as the peritoneal surfaces covering the bowel and bladder. Endometriotic lesions are commonly found in all of these areas. Laparoscopy also allows for treatment of endometriosis lesions during the same surgical procedure.
There is currently no cure for endometriosis. The goal of treatment is therefore to improve symptoms, preserve fertility for women who would like to postpone childbearing and infertility treatment for women who desire pregnancy. Medical and surgical treatment options for deeply infiltrative endometriosis are discussed in this web page.
Surgical treatment for superficial endometriosis (when lesions are just on the surface and don’t go deep into the tissues) should be treated at the time of laparoscopy.
Excision of endometriotic lesions or nodules involves cutting out visible areas of endometriosis (excision), or burning them off. Other medical terms that describe the destruction of endometriosis are “ablation and fulguration” which are used with different kinds of energy sources. Excision of superficial peritoneal endometriosis lesions has a benefit of providing pathological confirmation because the excised tissue is sent to the laboratory for evaluation. However, both excision and destruction/ablation techniques are equally effective with improving pain symptoms. Similarly, research studies have shown that both excision and destruction of endometriosis at the time of laparoscopy improves future fertility compared to diagnostic laparoscopy alone.