Endometriosis: A general review and rationale for surgical therapy

This review article aims to give a comprehensive insight into both the historical and current thoughts on all aspects of endometriosis including aetiology, diagnosis, and medical and surgical treatments. The prevalence of endometriosis is about 6–8%, and may affect up to two million women in the United Kingdom. It causes, through pain and infertility, a significant problem for sufferers, their families and society as a whole. There is no conclusive evidence to explain its aetiology although our understanding of the basic pathophysiology is improving. However, there remains a substantial lack of understanding in all areas of disease.A rationale is presented for surgical therapy as the preferred approach for diagnosis and treatment. The recognised gold standard for diagnosis is laparoscopy. Surgery is the only treatment modality that consistently eradicates all macroscopic diseases and can be carried out at the same time as diagnosis. There is no evidence that medical treatment is superior to surgical treatment. Surgical removal of endometriotic lesions is the only treatment that improves spontaneous conception rates in endometriosis-associated infertility. The evidence for the surgical techniques and energy modalities used for the surgical management of minimal to moderate endometriosis, endometriomas and recto-vaginal disease are described in greater detail.