Endometriosis

Abstract

Endometriosis is a disease defined by the presence of endometrial glands and stroma outside of the uterus. While non-fatal, endometriosis can be associated with disabling pelvic pain, abdominal pain, alteration in bowel habits, as well as intractable infertility. Colorectal surgeons become involved with intestinal involvement as part of the multimodal therapy team when endometriosis requires surgery in those patients with infertility, pelvic pain, obstruction, or poor response to hormonal therapy. Medical therapy has a role in treating endometriosis symptomatically to avoid the pitfalls of ablative surgery or the potential role in treating microscopic disease but requires long-term therapy. Surgical treatment has evolved dramatically over time, and conservative preservation of reproductive potential has become the norm. All surgical therapy for endometriosis is best defined as complete excision or ablation of endometrial implants while preserving ovarian function and minimizing postoperative adhesion formation. For many advanced lesions discectomy or low anterior resection may be required for complete extirpation.