Endometriosis is a benign condition that may affect up to 10% of women of reproductive age [1,2]. Exact prevalence is hard to determine since many patients are asymptomatic, including even cases with severe disease [3].It has been demonstrated that endometriosis might have a huge impact on the lives of affected women, their partners and their families [4]. In a previous retrospective study, 50% of women with surgically confirmed endometriosis reported a significant effect on education, work ability, relationship and social life [5].

Extrapelvic localization is reported to represent 5 % of lesions in patients with endometriosis, this rate is probably underestimated [6]. Several authors focused on clinical and pathological evidence on the involvement of pelvic nerves in women with endometriosis in recent years [7], [8], [9], [10], [11]. De Sousa et al. in their recent literature review reported 365 cases of patients with endometriosis and nerve infiltration, including involvement of the lumbosacral trunk in 57% and of the sciatic nerve [12] in 39% of cases. Further spread of the endometriotic lesions into the spinal nerves and even the dura of the spinal cord has been proposed to be a possible etiology of DIE [12,13].

The management of excessive endometriosis – related pain remains a medical challenge [14,15]. The benefit of surgery in endometriosis patients with pain and / or infertility has been extensively reported [16,17]. Currently, various surgical procedures may be required from uterosacral ligament resection to complex excision of nodules from bowel, urinary tract, nerves or blood vessels. These procedures carry a relative increased risk of complications, which correlate to the extent of the lesions and their tissue penetrance [18].

Little data exist on endometriosis patients with pelvic nerve infiltration. The ESHRE guidelines recently underlined that evidence to predict endometriosis based on clinical symptoms alone is weak and incomplete and women may present to their practitioners with a variety of non-specific symptoms [15]. This statement seems particularly relevant in patients who have nervous lesions and are often under diagnosed, despite having more frequently specific neurologic complains. Possover et al. reported several cases as well as cohorts of patients that underwent laparoscopic neurolysis for severe endometriosis, and demonstrated feasibility of improvement in terms of pain scale intensity [10,19]. However, such procedures are considered to be highly advanced laparoscopic procedures and carry significant surgical risks, even in the hands of experienced surgeons[18].So far, the most appropriate treatment for patients with proven pelvic nerve infiltration is unclear, with only few authors focusing on this unique site.

The aim of our study was to assess the benefit of surgical management of patients with endometriosis infiltrating pelvic nerves in terms of pain, analgesic consumption and quality of life. (QOL)