The goal of surgery is to eliminate all visible peritoneal lesions, endometriomas, DIE and associated adhesions and to restore normal anatomy. Since depth of infiltration is difficult to judge, excision or vaporization is preferable for typical lesions. Excision is the preferred method for endometriomas since recurrence rates following marsu-pialization and focal treatment are much higher. It is controversial whether conservative discoid resection or resection anastamosis of larger DIE lesions should be offered. Laparoscopy should be used as it decreases morbidity and the duration of hospitalization, and therefore cost, compared to laparotomy. Whether laparoscopy also reduces post-operative adhesions is less clear. If local expertise is lacking, then referral to a specialized centre with the necessary expertise to offer all available treatments in a multidisciplinary context, including advanced laparo-scopic surgery and laparotomy, is strongly recommended. This particularly applies if DIE or severe endometriosis is suspected or has been diagnosed. Lesions can be removed by surgical excision with scissors, ultracision or laser -CO2 or potassium-titanyl-phosphate (KTP).
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