Surgery for treatment of endometriosis

Question 1

Laparoscopy and endometriosis

Answer 1

• Excision or ablation are equally effective

- See and treat

Question 2

Nerve ablation and endometriosis

Answer 2

• Do not use Laparoscopic uterosacral nerve ablation
  (LUNA) as an additional procedure to conservative surgery to reduce endometriosis-associated pain
• Presacral neurectomy (PSN) is effective as an additional procedure to conservative surgery to reduce
  endometriosis-associated midline pain, but it requires a high degree of skill and is a potentially hazardous procedure
• Risks ass with PSN: bleeding, constipation, urinary
  urgency and painless first stage of labour

Question 3

Surgery for endometriomas

Answer 3

• Cystectomy rather than drainage

- Do not use CO2 vaporization to avoid recurrence

Question 4

Surgery for deep endometriosis

Answer 4

• Total intraoperative complication rate 2.1%,
• Total postoperative complication rate 13.9%
• Bladder endometriosis: excision of the lesion and primary closure of the bladder wall
• Ureteral lesions: excised after stenting the ureter
• Intrinsic lesions or significant obstruction: segmental excision with end-to-end anastomosis or reimplantation may be necessary
• Needs tx in tertiary centre

Question 5

Hysterectomy for endometriosis

Answer 5

• Hysterectomy with removal of the ovaries and all visible endometriosis lesions, in women who have completed their family and failed to respond to more
  conservative treatments
• Women should be informed that hysterectomy will not necessarily cure the symptoms or the disease

Question 6

Adhesion prevention after endometriosis surgery

Answer 6

• Clinicians can use oxidised regenerated cellulose during operative laparoscopy for endometriosis, as it prevents adhesion formation
• It is not reasonable for clinicians to use icodextrin after operative laparoscopy for endometriosis to prevent adhesion formation, as no benefit has been shown