Endometriosis in clinical practice: Surgical aspects

Summary

CLINICAL endometriosis normally derives from fragments of viable endometrium spilled into the dependent pelvic cavity, where they implant and grow on the local viscera. Occasional fragments are deported, mainly by blood vessels or lymphatics, to cause endometriosis in unusual and remote situations. Sometimes it is implanted directly into surgical wounds.

Ovarian sex hormones promote growth and cycical activity and so influence the clinical outcome. Ovarian activity can be manipulated to modify and suppress endometriosis. But although medical treatment must play a significant part, there are considerations of age, fertility, infertility, the extent, the location of endometriosis and particularly the involvement of other organ systems, that often make surgery the treatment of choice, and so the surgeon finds work which is challenging, sometimes difficult, and generally rewarding.