Controversies in the management of endometriosis: should we expand the definition?

Endometriosis is currently defined as the presence of endometrial glands and stroma outside the uterus. Unfortunately this definition, whilst widely utilised, is also widely recognised as only a part of the underlying disease process. At this point in time the underlying etiology of endometriosis is unknown despite large bodies of research. The simplistic use of…

Scar endometriosis

Over recent months I have seen an unusual number of patients with endometriosis in various scar sites.  The most common situation follows the performance of a caesarian section with a deposit of endometriosis within the operative field.  More rarely and usually without prior surgery (including laparoscopy) the umbilicus can be affected.  Interestingly I have not…

When should the bowel surgeon get involved with endometriosis involving the bowel?

The answer seems simple. The bowel surgeon should be involved early in the process. I agree. The bowel surgeon should ideally have the seen the patient in a pre-operative consultation to discuss the planned procedure, results and potential complications.  The intra-operative timing is the critical thing. If the gynaecologist has minimal surgical skills then invariably…

Dilemmas and controversies in the management of ovarian endometriosis and infertilty

A recent consensus statement on endometriosis and infertility indicates that some women may benefit from a combination of assisted reproduction and surgery.  Unfortunately the data are limited and somewhat conflicting. This is not uncommon when surgery is involved as there is inevitably a degree of operator (or surgeon) dependence. It is self-evident with diseases such…