ABSTRACT
For almost a century, the treatment of endometriosis has been based mainly on a straightforward oncologic principle, i.e., radical removal of lesions. This is still a mainstay of therapy in cases of bowel and ureteral stenosis or adnexal masses with ultrasonographic doubtful characteristics. However, endometriosis is not a cancer and, in the vast majority of patients, it does not cause intestinal or ureteral strictures. Moreover, in the past two decades, it became progressively evident that the overall “amount” of disease is correlated neither with frequency and severity of symptoms nor with longterm prognosis in terms of conceptions and recurrences (1,2). Furthermore, effective pharmacological alternatives have been developed to deal with a chronic inflammatory disease, such as endometriosis, that needs drug modulation for years, and not only for the arbitrary standard period of six months (3,4). Accordingly, a more pragmatic approach to the treatment of endometriosis was gradually developed, focusing more on the woman’s needs than on the extension of lesions (3). In other words, the problems of patients with endometriosis are disease-related symptoms and not implants per se, and treatments should be centered on resolution of complaints, independently of a priori excision of lesions.
