Ray Garry1. 1. University of Western Australia, School of Women's and Infants' Health, King Edward Memorial Hospital, Subiaco, Western Australia. rgarry@obsgyn.uwa.edu.au
Abstract
PURPOSE OF REVIEW: The optimum method for the treatment of endometriosis remains unclear. This review explores recent data concerning the effectiveness of laparoscopic excision and associated therapies, to guide clinicians in their selection of the most appropriate therapeutic regimen. RECENT FINDINGS: Large, long-term, prospective studies and a placebo-controlled, randomized, controlled trial suggest that laparoscopic excision is an effective treatment approach for patients with all stages of endometriosis. The result of such laparoscopic excision may be improved if affected bowel, bladder and other involved structures are also excised. Adjuvant therapies such as the levonorgestrel intrauterine system and pre-sacral neurectomy may further improve outcomes. Ovarian endometrioma are invaginations of the uterine cortex, and surgical stripping of this cortex removes many primordial follicles. Despite this apparent disadvantage, stripping of the capsule is associated with better subsequent pregnancy rates and lower recurrence rates than the more conservative approach of thermal ablation to the superficial cortex. SUMMARY: Laparoscopic excision is currently the 'gold standard' approach for the management of endometriosis, and results may be improved with careful use of appropriate techniques and suitable adjuvant therapies. Copyright 2004 Lippincott Williams and Wilkins
PURPOSE OF REVIEW: The optimum method for the treatment of endometriosis remains unclear. This review explores recent data concerning the effectiveness of laparoscopic excision and associated therapies, to guide clinicians in their selection of the most appropriate therapeutic regimen. RECENT FINDINGS: Large, long-term, prospective studies and a placebo-controlled, randomized, controlled trial suggest that laparoscopic excision is an effective treatment approach for patients with all stages of endometriosis. The result of such laparoscopic excision may be improved if affected bowel, bladder and other involved structures are also excised. Adjuvant therapies such as the levonorgestrel intrauterine system and pre-sacral neurectomy may further improve outcomes. Ovarian endometrioma are invaginations of the uterine cortex, and surgical stripping of this cortex removes many primordial follicles. Despite this apparent disadvantage, stripping of the capsule is associated with better subsequent pregnancy rates and lower recurrence rates than the more conservative approach of thermal ablation to the superficial cortex. SUMMARY: Laparoscopic excision is currently the 'gold standard' approach for the management of endometriosis, and results may be improved with careful use of appropriate techniques and suitable adjuvant therapies. Copyright 2004 Lippincott Williams and Wilkins
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