Surgical management of endometriosis

Abstract

Endometriosis is a chronic and multifactorial gynecological disease that affects a significant proportion of women of reproductive age, commonly presenting with symptoms such as chronic pelvic pain and infertility. Its management requires an individualized approach and, in many cases, surgical intervention—particularly when medical therapy is ineffective or contraindicated. This article reviews the various surgical approaches to endometriosis based on its clinical and phenotypic presentation: superficial peritoneal endometriosis, endometrioma, and deep infiltrating endometriosis (DIE). Laparoscopy has become the preferred surgical
approach due to its lower morbidity, reduced adhesion formation, faster postoperative recovery, and improved fertility outcomes compared to laparotomy. In complex
cases such as DIE with intestinal, bladder, or ureteral involvement, multidisciplinary collaboration is required, employing advanced techniques like discoid excision,
segmental bowel resection, or partial cystectomy. Although robotic surgery is a promising technology, current evidence does not demonstrate superior clinical outcomes compared to conventional laparoscopy and poses significant economic challenges. Surgical treatment should be planned and outlined in informed consent
based on symptoms and the extent of the disease, reproductive goals, and ovarian reserve, while also considering options such as fertility preservation. Informed decision-making, expertise in minimally invasive surgery, and interdisciplinary coordination are essential to optimize clinical and reproductive outcomes in patients
with endometriosis. Finally, it should be emphasized that endometriosis surgery is complex and should be performed by gynecologists who are experts in treating the disease.