Exxcellence pearls: surgical management of endometriosis Flashcards
List conservative surgical management for endometriosis.
Fulguration, laser ablation or excision of endometrial implants, lysis of adhesions, repair of tubal damage, uterosacral nerve ablation and presacral neurectomy
Was a gold standard for diagnosis of endometriosis?
Laparoscopy. Indicated when medical management fails.
What is the risk of endometriosis recurrence at 10 years after surgery?
What percent of patients will undergo additional surgery within two years?
40%
20%
What is presacral neurectomy?
What is the consensus on this treatment?
Excision of the presacral nerve plexus which carries pain signals from the uterus and cervix.
Randomized trial of laparoscopy with or without PSN showed that severity but not frequency of symptoms was less at 12 months.
What is laparoscopic uterosacral nerve ablation?
What is the current consensus on this treatment?
Disruption of the parasympathetic ganglia in the uterosacral ligaments which carry pain signals from the uterus, cervix and other pelvic structures.
Randomized trials have not shown a decrease in pain, dysmenorrhea, dyspareunia or dyschezia and thus LUNA is not recommended.
What medical therapy is recommended following surgery for endometriosis?
Continuous oral contraceptives or progestins, such as norethindrone acetate, DMPA or Mirena
In women over 40 with endometriosis, what percentage were surgery free after TAH alone?
TAH and BSO?
64%
96%
What can be said about definitive surgery for endometriosis in women aged 30-39?
Ovarian preservation does not negatively impact future need for surgery.
