Endometriosis occurs when endometrial glandular and connective tissue that should be present only in the endometrial cavity of the uterus also grows outside of the uterus. Endometriosis often grows in the pelvis on the lining of the pelvic floor, on the ovaries, tubes, and/or the outer surface of the uterus. This abnormal growth of endometrial tissue outside the uterus can cause chronic pain and infertility, causing symptoms that affect about 10% of reproductive-age women. Endometriosis often causes chronic adhesions/scar-tissue formation in the pelvis, and in some cases the endometriosis invades and destroys normal tissue on which it grows. The most common location of endometriosis is the pelvis, but it can involve almost any site and organ in the body. The most common symptoms are chronic pelvic pain, painful periods, pain with intercourse and infertility. Some patients may have painful urination or bowel movements, and rarely even bleeding into the urine or intestines during menstruation. Since endometriosis can occur in many different locations in the body, there are a large number of possible symptoms. Finally, endometriosis can grow inside the abdominal wall, forming painful nodules, especially at surgical scars from prior open (ex: cesarean delivery) or laparoscopic surgery.
Best treatment of endometriosis varies based on the individual patient, for example, women who have completed childbearing versus women who desire future fertility. For most women with very symptomatic endometriosis, this is a chronic condition that needs a combination of medical and surgical treatment until menopause and/or definitive surgery. Accumulating many surgical procedures over one's lifetime should be avoided. Unfortunately, some women have had several minor/diagnostic laparoscopies for endometriosis without having good excision of endometriosis or definitive surgery. Also, many women can avoid repeated surgeries with successful medical management of endometriosis. Effective medical management of endometriosis can also help prevent loss of fertility and recurrence or progression of symptomatic endometriosis.
Surgery for endometriosis can be complex depending on the findings at the time of surgery. Preoperative imaging studies such as ultrasound and MRI perform poorly for predicting the burden of endometriosis or extent of adhesions in the pelvis. Most gynececologists do not routinely perform complex procedures for advanced or deeply invasive endometriosis. These procedures are best performed by surgeons who can safely and efficiently perform complex excisional procedures for endometriosis laparoscopically or robotically with low complication rates, low rates of aborted procedures, and low rates of conversion of the surgery to an open procedure with a large incision.
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