Surgical management of endometriosis

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Endometriosis is the presence of endometrial glands or stroma outside of the uterine cavity. While it is difficult to estimate overall incidence, it is thought that up to 10% of reproductive-age women have endometriosis, which can often result in infertility and pelvic pain. The variation and spectrum of symptoms produced by endometriosis can make patient management challenging, as some patients will present with debilitating pelvic pain and some will have few, if any, symptoms. Definitive diagnosis is made surgically, often with histological correlation. Symptomatic women can be managed either medically or surgically. Further complicating the treatment is the infertile patient with known or suspected endometriosis. While surgical treatments may benefit many patients with endometriosis-associated infertility, there is a subset of patients who may benefit more from proceeding to assisted reproductive technology. This paper will discuss surgical management of endometriosis in women with the primary complaint of infertility and women with the primary complaint of pain. Additionally, we will cover the surgical management of endometriomas, as well as their impact on fertility. Finally, we will discuss recurrence following surgical treatment. In all women with endometriosis, recurrence is common and measures must be taken to reduce the recurrence risk after any treatment.

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