Besides the pain, there are two further problems in the management of endometriosis: the high recurrence rate of 10% per year and the high rate of impaired fertility. The pathogenesis, of these two factors, is not completely investigated.This is a cohort retrospective study and aim of this study is to evaluate the complete excision of endometriotic lesions including posterior compartment peritoneum considering postoperative outcome, focusing on pain devolution, fertility rate and recurrence rate.Charité University clinic, Department of Gynaecology, Endometriosis research Centre.54 patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (rASRM I=3; II-15; III-10; IV-26).Posterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as a part of the complex surgery: complete excision of endometriosis.Postoperative outcome was evaluated, based on the post-operative follow-up (up to 5 years) from 54 investigated patients. In 36 women (66%) pre-operative complaints were eliminated. Furthermore, from 28 women seeking fertility, pregnancy was reported in 13 cases (46%). Remarkably, in 7 (54%) cases pregnancy occurred spontaneously and in the remainder with assisted fertilization. Additionally, long-term follow-up demonstrated a recurrence rate in 1.8% of patients.Overall, the number of complaints was significantly reduced. Only in the case of persisting adenomyosis patients suffered from ongoing postoperative complaints, as in reproductive aged women keeping the uterus was highly required. Although this pilot study about systematic posterior peritonectomy showed improved recurrence rate and fertility rate, the main question remains: does this surgical technique appropriate better results and outcomes in the future. This question has to be addressed in a prospective randomized study.