No abstract

the disease into numerous subtypes based on clinical, surgical and radiological appearances (5-7). Widespread implementation of these systems however is still lacking and their use in predicting clinical outcomes remains unclear. The initial diagnosis is clinical. Diagnostic imaging modalities including transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) provide further information regarding the size, location, extent and degree of infiltration of lesions but they cannot accurately predict the degree of technical difficulty that will be encountered at the time of surgery. Most authors recommend surgery as the primary treatment modality (1, 3, 8) as medical therapy only provides short-term symptom relief. The outcome after conservative or radical laparoscopic surgery is not well documented. Incomplete lesion resection does not appear to be of any benefit, whilst radical resection is associated with major complications including bowel and ureteric injuries (9). The complication rate after laparoscopic surgery for deep endometriosis is estimated to be 3.4%, rising to 10%-22% when colorectal resection is necessary (4). The debate continues as to which surgical approach is the most appropriate. Level 1 evidence is lacking. Although there have been several studies looking at this, the majority of them originate from Europe and North America. The relationship between infertility and rectovaginal endometriosis remains controversial. Spontaneous pregnancy