Surgical treatment of endometriosis

Surgical treatment of endometriosis

Disease Patterns


  1. Simple disease pattern: corresponds to stages I and II disease


  1. Normal pelvic architecture serves as a platform for subtle and con­spicuous endometriotic lesions.
  2. In our referral center, 75% of cases are simple.


  • Subtle forms of endometriosis


  • Peritoneal pockets with endometriosis (Miillerianosis)
  • Nonpigmented peritoneal and ovarian endometriosis
  • Slightly enlarged “normal ovary” with deep endometrioma
  • Ovarian endometriosis hidden by surface adhesions
  • Early bowel endometriosis
    • Conspicuous form of endometriosis
      • Deeply pigmented peritoneal and ovarian lesions
      • Ovarian endometriomas
      • Constricting endometriotic lesions of ileum and colon


  1. Complex disease patterns: corresponds to stages III and IV


  1. Distorted pelvic architecture: There are thresholds of increased complexity until irreversible damage occurs. The surgeon must understand the evolution and development of complex disease pat­terns to resolve them successfully by surgery.
  2. In our referral center, 25% of cases are complex.


  • Centrifugal pattern: obliterated rectovaginal pouch with rectum and ovaries attached to retroverted uterus
  • Left-frozen pelvis: sigmoid colonic adhesions obliterate the left adnexa, which is also densely adherent to left pelvic wall
  • Obliterated rectovaginal pouch of Douglas: rectum densely adherent to posterior uterus
  • Centripetal pattern: ovaries adherent laterally with or without an obliterated rectovaginal pouch of Douglas
  • Complete frozen pelvis


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