Without a laparoscopy

• the diagnosis is only a suspicion of superficial endometriosis, except when a cystic ovarian endometriosis was diagnosed by ultrasound
• If pain started suddenly endometriosis is unlikely.  A cystic corpus luteum needs to be excluded.
• If a BIG deep endometriosis nodule is diagnosed by clinical exam or ultrasound (MRI), the diagnosis is probably correct ; for smaller lesions the risk of false positives and of false negatives is high
• If  the type of endometriosis was not explained, your gynecologist is probably not a specialist

If a laparoscopy is planned, then check planning

• • A cystic ovarian endometriosis of more than 6 cm needs surgery in 2 steps otherwise the ovary risks to be destroyed.
  • For large deep endometriosis, hydronefrosis  (e.g. with  ultrasound) and bowel stenosis (with a contrast enema) need to be excluded
  • An ureter stent is indicated only in cases of hydronefrosis  

although many surgeons continue to use stents in all women with deep endo .

• Check the expertise of the surgeon and his percentage of bowel resections. Bowel resection are rarely needed  (<5%) and should be decided during surgery. .

If surgery was not performed during laparoscopy

• This should have been agreed in the informed consent to prevent medicolegal problems
• Check the photo’s or video to ascertain what  has been checked: e.g. the appendix, the sigmoid and diaphragm. Without video-registration it will remain unclear.

If surgery was performed,  you should

• check videoregistration to know
  • the type of intervention is
  • complete or incomplete excision  ?
  • complications  ?
  • duration of surgery ?

Medical treatment was given without a laparoscopy

• this can be done occasionally not as a preparation for surgery
• this can be given for a short period to evaluate the effect on pain
• for a longer period without a diagnosis is generally a mistake