When to do surgery and when not to do surgery for endometriosis: a systematic review and meta-analysis

Endometriosis is an inflammatory disease characterized by endometrium-like lesions outside the uterus. Pelvic pain and infertility are hallmarks of the disorder. The correlation between the severity of a patient's symptoms and disease state is weak; some patients with advanced endometriosis are asymptomatic. Although some patientswith endometriosis are infertile, others are not. Treatment options include both medical and surgical management.Medical alternatives include hormonal contraceptives, progestins, and gonadotropin-releasing hormone agonists or antagonists. Laparoscopic surgery consisting of excision and ablation is frequently a part of treatment. Therapeutic decision making is complex and difficult in large part due to the heterogeneous population of patients and the numerous phenotypes of endometriosis. Moreover, the setting in which health care takes place (accessibility and cost of treatment) and patient preference play large roles in treatment decisions. The aim of this systematic review and meta-analysis was to determine whether operative laparoscopy is an effective and safe treatment for women with demonstrated endometriosis compared with alternative treatments. Other aims were to understand whether the timing of surgery affects these outcomes, to assess the risks of operative laparoscopy, and to evaluate the impact of patient preference on decision making around surgery.