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Advances in preoperative diagnostic as well as surgical techniques for the treatment of endometriosis, especially deep endometriosis call for a classification system that includes all aspects of the disease such as peritoneal, ovarian endometriosis and deep endometriosis and secondary adhesions. The widely accepted r-ASRM classification has certain limitations due to its incomplete description of deep endometriosis. In contrast, the Enzian classification, which has been implemented in the last decade, has proved to be the most suitable tool for staging deep endometriosis but does not include peritoneal or ovarian disease as well as adhesions. To overcome these limitations, a comprehensive classification system for complete mapping of endometriosis, including anatomical location, size of the lesions, adhesions and degree of involvement of the adjacent organs that can be used with both, diagnostic and surgical methods, has been created via a consensus process and will be described in detail-the #Enzian classification.

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

" Gynecological Endoscopy Study Group (Arbeitsgemeinschaft für Gynäkologische Endoskopie, AGE) " Gynecological Oncology Study Group (Arbeitsgemeinschaft für Gynäkologische Onkologie e. V., AGO) " German Society for Gynecological Endocrinology and Reproductive Medicine (Deutsche Gesellschaft für Gynäkologische Endokrinologie und Fortpflanzungsmedizin e. V.) " German Society for Psychosomatic Obstetrics and Gynecology (Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe, DGPFG) " German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemeinund Viszeralchirurgie e. V., DGAV) " German Society for Urology (Deutsche Gesellschaft für Urologie e. V.

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