Endometriosis Surgical Algorithm

Endometriosis Surgical Planning Algorithm – Comprehensive Guide

Why is Surgical Planning Important?

Endometriosis surgery varies according to the extent and depth of the disease. Proper planning reduces complications, increases surgical success, and lowers the risk of recurrence.

Step 1: Clinical Evaluation

The patient's complaints (pain, infertility), symptom duration, previous surgeries, and quality of life should be evaluated in detail.

Step 2: Imaging

The extent of the disease, deep infiltrative foci, and organ involvement are determined by transvaginal ultrasound and, if necessary, pelvic MRI.

Step 3: Classification

The stage of the disease and the degree of surgical difficulty are determined using ASRM, ENZIAN, and AAGL classifications together.

Step 4: Fertility Plan

The patient's desire for pregnancy should be evaluated. In patients with a desire for fertility, surgical planning is done while preserving ovarian reserve.

Step 5: Multidisciplinary Approach

If there is bowel, bladder, or ureter involvement, planning should be done in conjunction with general surgery and urology.

Step 6: Surgical Technique Selection

Minimally invasive techniques such as laparoscopy and vNOTES are preferred. Excision of lesions, adhesiolysis, and, if necessary, organ resection are planned.

Step 7: Nerve-Sparing Surgery

Preservation of pelvic nerves is important for the continuation of postoperative functions.

Step 8: Complication Risk Assessment

Risks such as bleeding, organ injury, and fistula should be evaluated beforehand, and the patient should be informed.

Step 9: Postoperative Plan

Hormonal therapy, pain management, and, if necessary, fertility treatments should be planned.

Step 10: Follow-up

Patients should be regularly followed up and evaluated for recurrence.

Conclusion

Endometriosis surgery should be planned with an individualized approach. Surgery performed by multidisciplinary and experienced teams provides the best outcomes.