TREATMENT OF DEEPLY INFILTRATING ENDOMETRIOSIS

Deep endometriosis has been defined as endometriosis infiltrating deep er than 5 mm under the peritoneum. A model for the development and pro pagation of endometriosis is presented. Subtle and non-pigmented lesio ns are suggested to occur intermittently in all women. Infiltration oc curs generally to a few millimeters of depth only, and these lesions b ecome typical, burnt out lesions. In some 20% of women, severe endomet riosis develops either as deeply infiltrating disease or as cystic ova rian disease. Arguments are given to consider deep endometriosis and c ystic ovarian endometriosis as two specific entities of endometriotic disease. A possible causal relationship with dioxin pollution is discu ssed. Diagnosis of deep endometriosis is made by clinical examination and palpation during surgery. Clinical examination during menstruation and CA-125 concentrations in plasma are useful to help in the diagnos is of smaller deep lesions. Surgical excision can be carried out by la paroscopy, laparotomy or vaginally using sharp dissection, electrosurg ery or with the use of a CO2 laser. Excision is the treatment of choic e because of a high pregnancy rate, a complete cure of pain in most wo men, and a low recurrence rate. Medical treatment is probably less eff ective to treat infertility, but highly effective in relieving pelvic pain. Medical therapy, by luteinizing hormone-releasing hormone agonis ts, danazol, or gestrinone, also seems useful as a pretreatment for su rgery. The choice of treatment will therefore depend on the local expe rtise with minimal invasive surgery, certainly if a first excision has been incomplete and pain symptoms recur.