Conservative and Fertility Sparing Surgery for Treating Endometriosis

Abstract

Endometriosis is a common disease that affects 6%-10% of reproductive-age women. There are many approaches to the treatment of endometriosis ranging from medical therapy to extirpative surgery. For a woman desiring fertility-sparing treatment, or simply not desiring a hysterectomy, conservative surgical treatment may be suggested. This method is often challenging due to the extent of peritoneal involvement, dense adhesions, and deep infiltrating disease. Later-stage endometriosis can obscure tissue planes and put major pelvic structures at risk of injury. It is therefore important to have a solid knowledge of pelvic anatomy, including the retroperitoneal spaces, and to be prepared for extensive dissection to identify these structures clearly. Prior to proceeding to the operating room, the surgeon must counsel the patient thoroughly about surgical risks, including the risk of inability to salvage reproductive structures for optimal treatment of the disease. Using joint decision-making, the surgeon and patient can form a plan for the extent of surgery acceptable to the patient. This article discusses conservative excisional surgery for treating endometriosis, as well as methods and surgical principles, for patients desiring preservation of reproductive organs.