Laparoscopic Removal of Endometriosis in the Pouch of Douglas

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Abstract
EDITORIAL COMMENT": This paper provides important data on dealing, via the laparoscope, with endometriosis involving the uterosacral ligaments and peritoneum of the pouch of Douglas in patients with pelvic pain and/or infertility. None of the 26 women in this study had had a hysterectomy, although this procedure usually relieves pain associated with endometriosis involving the pouch of Douglas and uterosacral ligaments. Perhaps we require more data regarding symptoms from residual endometriosis in patients having hysterectomy and uterosacral endometriosis; relevant considerations include whether bilateral oophorectomy is also performed or whether the patient receives postoperative hormone replacement therapy in this circumstance. It seems to the editor that the uterosacral ligaments and pouch of Douglas are seldom removed when hysterectomy is performed in the type of cases reported in this paper; one achieves mobility of the uterus before its removal by cutting the uterosacral ligaments, not removing them; in these cases we are concerned about the keeping away from the ureters and rectum rather than excising scarring due to endometriosis ‐ yet the authors note that ‘biopsy of scarred lesions often shows active endometriosis!Summary: Twenty‐six patients with endometriosis in the pouch of Douglas were treated by laparoscopic excisional surgery; previous medical and surgical therapy had failed in 24 of them. Endometriosis in the pouch of Douglas occurred infrequently in association with bladder or ovarian endometriosis. Coital and rectal pain were markedly reduced or cured 6 months after surgery in all except 2 patients. Laparoscopic surgical excision of endometriosis is indicated when drug or other surgical treatments fail and may avoid the need for hysterectomy in some patients.