Endometriosis: does surgery make a difference?

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July 2002 · Vol. 14, No. 7

Endometriosis: does surgery make a difference?

There appears to be value in treating pain and infertility, yet it may be far less than anticipated. Here, the author reviews various techniques.

David L. Olive, MD

Dr. Olive is a professor of OBG and chief of reproductive endocrinology and infertility at the University of Wisconsin–Madison Medical School in Madison, Wis.

Key points

The relative value of surgery in the treatment of endometriosis—when compared with medical therapy for pain relief or assisted reproduction for fertility enhancement—has yet to be adequately evaluated.
Although surgery appears to enhance fertility for all stages of the disease, the effect is marginal with early-stage disease.
Laparoscopy produces excellent results and should be the method of choice for the surgical management of endometriosis.
Endometriomas are best treated by removal rather than simple drainage and coagulation.

Surgery traditionally has been a mainstay in the treatment of endometriosis, one of the most common and debilitating diseases in benign gynecology. Surgeons were the first to attack the disease, and surgery remained the primary therapy through the 1970s. Only recently, with the development of drugs to combat endometriosis and techniques to circumvent the pelvic damage associated with the disease, has surgery begun to take a back seat to other therapeutic approaches.

The magnification afforded by laparoscopy frequently facilitates a more precise technique.

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