The role of surgery in the management of endometriosis.

Surgery has a specific and realistic place in the management of endometriosis. In the presence of an ovarian mass, diagnosis to rule out neoplasm is mandatory. Therapeutic surgery is carried out for the relief of pain when there is known symptomatic endometriosis or to provide improved chances of a successful gestation when there is infertility. The use of hormones preoperatively has not been routine but seems to be logical when there is extensive and significant scarring. It would seem appropriate to attempt to preserve childbearing function in those patients who are young and desirous of this. In older patients or those in whom the childbearing is complete, it seems unwise to leave behind diseased tissue that can require a subsequent operation. Conservative surgical treatment for infertility related to endometriosis has about a 40 percent chance of successful pregnancy; such conservative treatment carries a 10 to 12 percent risk of subsequent reoperation. The rate of malignancy in endometriosis is low. Intestinal tract endometriosis is uncommon. Bowel preparation is recommended if bowel surgery is anticipated because of the endometriosis. Urinary tract endometriosis is even more uncommon with the exception of the extrinsic pressure and scarring secondary to extensive pelvic endometriosis. tsurgical treatment seems to be of more value than hormone therapy when other organs are involved.