Can extensive endometriosis be adequately treated at laparotomy?
Treatment options for pain or infertility secondary to cul-de-sac obliteration include ovarian suppression therapy with danazol or gonadotropin releasing hormone agonist, or surgery. For present infertility or the preservation of fertility, reconstructive surgery can be considered either via laparotomy microsurgery or laparoscopy, depending on the skill and experience of the surgeon. For pain, when future fertility is not desired, hysterectomy with bilateral salpingo-oophorectomy is performed commonly. The problem with the hysterectomy approach is that it is usually performed with an intrafascial technique, leaving fibrotic endometriosis on the vagina and rectum, assuming that it will resolve after castration; future surgical procedures may be necessary for pain from vaginal cuff or rectal endometriosis. At laparotomy, retrocervical deep fibrotic endometriosis should usually be managed with bowel resection, assuming that the major portion of the lesion infiltrates the anterior rectum.
