Endometriosis: Why Excisional Surgery?
Historical excision – sampson
- Generally progressive disease
- ‘Iceberg’ philosophy
- Relative failure of traditional therapy
Sampson described endometriosis in the early 1920s and initially advised excision although noted that surgery for extensive bowel involvement was an unsettled question. During last century most surgeons then moved to a conservative ablative approach and some are now moving back to a more extensive excisional approach.
It is worth noting that even today the traditional approach involves laparoscopic ablation, medical therapy & then resort to hysterectomy & bilateral salpingoophorectomy even if deeper disease is left behind. Despite the unknown aetiology, the most promising data appears to suggest we should probably be attempting to remove all the endometriosis, not unlike our approach to malignancy.
This strategy increases fertility and decreases pain with success rates above that of simple observation, medical therapy or surface ablation. No medical therapy has yet been shown to eradicate endometriosis. Progressive disease but not in terms of different areas.