Despite its prevalence, there is no optimal treatment for endometriosis; recurrence of disease is a common problem. Laparoscopic surgery compared with medical therapies shows improved patient satisfaction outcomes in general health, quality of life and emotional wellbeing. Management of this varied aetiology improves in the context of a multidisciplinary team.

CA 125≥30u/ml is highly predictive of endometriosis in women with symptoms of pain and/or subfertility. CA 125 should be considered as a rule-in test for expediting the diagnosis and management of endometriosis, CA 125 <30u/ml is, however, unable to rule out endometriosis.

Access to accurate imaging modalities such as MRI and transvaginal ultrasound allows for adequate patient counselling preoperatively. Depending on the fertility requirements and the extent of adenomyosis, patients can be offered various surgical treatment options including laparoscopic hysterectomy or adenomyomectomy.

This report is aimed at describing the effects and complications of a polypropylene mesh in standard gynaecological practice. This is single centre prospective cohort observational study performed at a University affiliated hospital in the UK. It involved the prospective symptom assessment of 41 consecutive patients in 2007 who underwent anterior and/or posterior Avaulta Plus™ or Avaulta™ Biosynthetic Support System (BARD). The validated International Consultation on Incontinence Modular Questionnaire - Vaginal Symptoms (ICIQ-VS) was completed in the clinic preoperatively. Postal questionnaires were sent to the patients up to 3 years postoperatively. Preoperatively the mean overall Quality of life (QoL) was 19.78 (SD 9.052) and at follow-up was 1.67 (SD 1.0) with p< 0.008. Mean VAS preoperatively was 15.00 (SD 7.566) and at follow-up was 0.44 (SD 0.882) with p< 0.008. A decrease in this score over time, indicates improved symptoms. In select patients, repair with mesh augmentation using Avaulta™ or Avaulta Plus™ is a safe and effective procedure up to 3 years with a median follow-up of 27 months (range 20-36 months).

for this study were recruited as part of an ethically approved project looking at gene expression in endometriosis. Women who were undergoing laparoscopy for the treatment of endometriosis between 18 and 50 years of age were recruited with informed consent. These women were known (or strongly suspected from investigations) to suffer from endometriosis. Exclusion criteria involved the presence of any metabolic and/or endocrinological disorders, alternate benign pathology (such as fibroids, polyps and PID), the presence or past history of malignancy, or the use of steroid or hormonal therapy in the preceding 6 months. No patient recruited had a known psychiatric history.Information about the study was given in the gynaecology out-patient department (GOPD). A patient information pack on endometriosis was distributed to all recruited candidates. Any questions were answered and further explanations requested by the patients were given. Candidates for the study had a full medical history taken by the chief investigator to assess and reconfirm eligibility for inclusion. The date of the last menstrual period was recorded for all candidates to assess menstrual cycle phase. This was confirmed by serum measurements of their hormonal profiles. A pregnancy test was performed prior to surgery and all tests were confirmed to be negative. Final consent for surgery was taken on the morning of the surgery and quality-oflife questionnaires including SF12 and SF36 together with a pain-score questionnaire PIQ6 were completed by the patient prior to surgery enabling preoperative assessment of the impact of endometriosis on the patient's daily life. The subjective patient pain levels for dysmenorrhoea, deep dyspareunia, dyschezia, urination, chronic pelvic pain and midcycle pain, were recorded on a nonnumerical linear scale as described below (Fig. 1). The scales and quality-of-life and pain questionnaires were compared pre and postoperatively at 6 and 12 months to assess for changes.All the cases assessed in the prospective symptom study underwent therapeutic laparoscopy by the same surgical team, in the same department, utilizing similar operative techniques. Therapeutic laparoscopy has been shown in studies to reduce the levels of symptoms and pain when compared with diagnostic laparoscopy [1,2]. In the anaesthetic room, at routine patient cannulation for surgery, blood was also taken for Ca125, CEA, Ca19.9, TFT, serum estrogen, serum progesterone, follicle-stimulating hormone (FSH) and leutenizing hormone (LH) levels to exclude confounding medical conditions, which could alter symptom presentation.Recruited cases were followed up with symptom questionnaires at 6 and 12 months postsurgery and results were analysed. A total of 21 patients were recruited and followed up at 6 months and 12 months respectively after their endometriosis surgery. All patients had been diagnosed at surgery to have stage 2-4 endometriosis.Patients were assessed for the following criteria as described in the validated standardized SF36 [3], SF12 [4] and PIQ6...