This article originally published in Endometriosis News Sept 9,2016 by Magdalena Kegel

Researchers recently reviewed published reports on the use of different surgical methods for deep infiltrating endometriosis, attempting to tease out which methods are most useful under different circumstances.

The study, “Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options,” was published in the journal BioMed Research International.

Deep infiltrating endometriosis, where endometriotic tissue penetrates and starts growing in other tissue, is the most severe form of endometriosis. Medical treatment that might lessen the symptoms is linked to side effects, and researchers are in agreement that surgery is the best option.

Various surgical methods exist, but the authors of the review, scientists from theUniversity of Messina in Italy, state that laparoscopy, commonly known as keyhole surgery, is the best approach to speed recovery and minimize disfiguring scars.

In addition to some non-invasive methods to find deep endometriotic lesions, such as transvaginal ultrasonography, colon X-ray, and magnetic resonance imaging (MRI), keyhole surgery may be needed to localize lesions.

Researchers suggest that surgery should always be performed by a gynecologist who is expert in endoscopic surgery, working together with a colorectal surgeon, since the intestines and rectum are often affected. If intestines are involved in the lesions, a multidisciplinary surgical team is needed to remove the endometriosis. Surgeons with additional specialties, such as urologists, might also be needed to improve the outcomes.

The main question many surgeons face is whether to use a technique where affected tissue is shaved off, or a method using a full surgical incision. These decisions, the researchers state, depend on the spread of the lesions — whether they are concentrated in one area or in many different locations. The particular location of the endometriosis should also affect the choice of method.

Generally, surgical shaving should only be used in superficial endometriosis where muscles are not affected. The authors also recommend that full incisions be used when the intestines are involved, but state that it is difficult to make recommendations based on published data, since individual surgeons tend to use only one of these methods, making the effective comparing of methods difficult.

“Future investigations should be focused on ensuring the radical excision of endometriotic lesions saving the function of all the organs involved by the disease, using minimal surgical access possible. Future efforts should improve long-term outcomes with regard to symptoms, quality of life, cosmetic outcome, recurrence rate and fertility,” the authors concluded.