Endometriosis: when is surgical treatment indicated?

Although oral contraceptives provide the primary therapy for endometriosis, surgery is sometimes indicated. Surgical treatment should be conservative, with salvage of as much tissue as possible. Ovarian and presacral neurectomy, in addition to dissection and desiccation, should be done in most cases. Hysterectomy is often elected by middle-aged patients in preference to almost continual suppressive therapy. Retroperitoneal endometriosis must be treated by dissection and electrocoagulation to prevent ureteral obstruction.