Endometriosis is a common and chronic inflammatory disorder affecting 10%–16% of women of reproductive age. Although endometriosis is a benign condition, it has negative effects on the quality of life and fertility of women affected. The annual cost in the United States from endometriosis is estimated at $65 billion, because of lost productivity and medical expenses. The socioeconomic impact of endometriosis is evident; however, effective treatment options elude clinicians. Medical management typically consists of nonsteroidal anti-inflammatory drugs and hormonal drugs that suppress ovarian function. Often, however, medical treatment regimens do not satisfactorily alleviate the intractable pelvic pain and are counterproductive for fertility. When medical treatment is suboptimal for managing endometriosis-related symptoms, complete excision of the deeply infiltrating lesions, endometriomas, and associated scar tissue can significantly alleviate pain and improve fertility. In this review, the current management of deeply infiltrating endometriosis, focusing on the surgical treatment of deeply infiltrating disease in the pelvis, urogenital tract, bowel, diaphragm, and chest, are discussed. (J GYNECOL SURG 29:118)
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