“Origins of deep infiltrating endometriosis” appeared in the British journal of Obstetrics & Gynaecology (August, 2011). The brief note explained the causes as injuries in childbirth and straining during defecation. In China you can add three or four surgical terminations of pregnancy where pulling on the cervix under general anaesthesia causes injuries to the uterosacral ligaments and their contained nerves. Regrowth of nerve-lets results in serious pain some years later.
The reply from the Clermont -Ferrand groups is interesting. Drs Kondo and Canis said that “surgery is not indicated for all women”. Indeed they reserve it for women who are “not responsive to medical treatment”, and claim that “pain improvement is significant despite the radicality of the surgery.” But “the dissection must be precise, meticulous and adapted to the size and extension of the lesion.” It is almost always the case in endometriosis that one group of surgeons claims they do a more meticulous procedure than another group. Some surgeons claim that others do not see the full extent of the endometriosis – and therefore fail to resect it all. The keyhole teams are particularly keen on this argument.
The important point is that the only randomised controlled trials of surgical treatment (Sutton, 1995) shows that there is a short beneficial effect for six months prior to the pain returning. I say that is likely to result from underlying injuries to pelvic nerves and NOT deposits of endometriosis.