Endometriosis

What is Endometriosis?
Endometriosis is the presence of endometrial tissue (tissue identical to the endometrium, the uterine lining) outside the uterus. Usually the endometriotic implants are located in the pelvis but endometriosis may also involve other parts of the abdominal cavity, the abdominal wall and, rarely, other locations such as the chest.

How is Endometriosis Diagnosed?
Endometriosis may be suspected in women of reproductive age with pelvic pain, infertility, or irregular uterine bleeding. Pelvic exam may reveal a retroverted (tilted backwards) uterus, tender adnexae (ovaries and tubes), enlarged ovary due to cyst(s) or tender nodules in the cul de sac (the space between the uterus and rectum.)

Ultrasound usually cannot diagnose endometriosis because the small implants are not visible. In some cases, ultrasound identifies a typical chocolate cyst in the ovaries, suggesting endometriosis.

Laparoscopy (or laparotomy) with direct visualization and biopsy of the implants are the only definitive diagnostic measures. At surgery the extent and severity of the disease can be assessed allowing optimal treatment planning; at surgery the disease can also be treated by means of surgical removal, laser, cautery, etc.

What is the Surgical Treatment for Endometriosis?
Surgical treatment of endometriosis is indicated when medical treatment fails, when large endometriomas (ovarian chocolate cysts) are present, or in the treatment of infertility.

The role of surgery, via laparoscopy or laparotomy, is to resect or destroy endometriotic implants, remove an endometrioma, remove pelvic adhesions and repair obstructed fallopian tubes (tuboplasty.)