Current Role of Surgery in Endometriosis; Indications and Progress-Crimson Publishers
Abstract
Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.
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