Laparoscopic Excision of Deep Fibrotic Endometriosis of th..

The most common presentations of endometriosis include pelvic pain, infertility, and adnexal mass. The ovaries, the posterior leaf of the broad ligament, and the cul-de-sac of Douglas behind the uterus are the most common locations of endometriosis, and the left side is more frequently affected than the right, as the rectosigmoid and its mesocolon both often involved with endometriosis enter the pelvis from the left side. Extensive endometriosis refers to bulky deep fibrotic endometriosis deposits that can often be palpated preoperatively as tender pelvic nodules. These nodules consist of endometriotic glands and stroma surrounded by fibromuscular tissue that have accumulated over many years in response to cyclic monthly activation of the endometriosis. They represent a long-standing chronic inflammatory response. Histopathologic examination to document endometriotic glands and stroma is necessary to substantiate a diagnosis of the endometriosis in any suspect lesion.