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.
Diagnosis
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.
Treatment
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 Removal and Destruction
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, which is also termed "ablation and fulguration." Excision of superficial peritoneal endometriosis lesions has a benefit of providing pathological confirmation because the excised tissue is sent to the laboratory for evaluation. Additionally, excision has been associated with improved fertility rates. However, studies to date have shown that both excision and destruction/ablation techniques effectively improve pain symptoms.
Summary
- Laparoscopic surgical treatment of superficial peritoneal endometriosis improves both pain symptoms and fertility outcomes.
- Excision and destruction (burn-off = ablation, fulguration) of superficial peritoneal endometriosis are equally effective in improving pain symptoms and fertility outcomes.
- Ovarian endometriosis (endometriomata cysts) is best treated with excision techniques in order to preserve fertility potential and obtain effective pain relief.
