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 gynaecologist is probably not a specialist

If laparoscopy is planned, then check the planning

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

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 video registration to know
  • which type of intervention you had
  • was the excision complete or incomplete.
  • 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