Endometrioid cysts: a modern surgical treatment strategy

Within current clinical guidelines there is a clear trend towards a decrease in surgical activity in endometriosis due to the possible adverse effect that surgery on the ovaries has on the ovarian reserve and the achievement of pregnancy. In the absence of contraindications preference is given to long-term hormone therapy or the use of assisted reproductive technologies. The aim of the study was to analyse and compare existing scientific studies and clinical guidelines for the treatment of endometriosis and overcoming female infertility in order to develop the most rational approach to surgical interventions for external genital endometriosis (EGE). Methods: The study analysed Russian and international scientific articles on endometriosis and female infertility, clinical guidelines and treatment protocols published in 2013-2020. In the studied sources, special attention was paid to the verification of the diagnosis of EGE, indications for surgical treatment, and currently accepted patient management regimens. Results: The study showed that the main indications for surgery remain the presence of large endometriomas, as well as genital endometriosis associated with pelvic pain or infertility with ineffective hormonal therapy or ART programs. In the presence of infertility and endometriosis, the patient should be informed about the possible decrease in the ovarian reserve associated with surgical treatment; consultation with a reproductologist is required. Conclusion: Treatment of endometriosis should remain as personalised as possible, with particular attention paid to defining clear indications for surgical treatment. An absence of specific reproductive plans allows for empirical hormone therapy to treat the patient and postpone surgery. The surgical stage of the treatment should be single-stage, optimal in intervention volume, radical in regard to the foci of endometriosis, and performed in the most appropriate period.