Background: Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus, is a frequent gynaecological disease. Accurate diagnosis and staging of endometriosis by imaging is essential to accurately guide the clinician in disease management. Transvaginal sonography (TVS) is a cost-effective meth-od compared to MRI in the diagnosis of endometriosis specifics.  
Aim: To evaluate the accuracy of TVS in the detection of pelvic adhesions caused by endometriosis.
Methods: This prospective cohort study enrolled 80 cas-es diagnosed with endometriosis were subjected to lap-aroscopy. Transvaginal ultrasonography was done using 2D and 3D scan without any bowel preparation and was guided by Adhesion scoring system. Transvaginal ultra-sonography was used to detect the presence or absence of adhesions using the sliding sign approach.
Results: Concerning the severity of endometriosis based on the r-ASRM classification, the number of cases with disease stages I and II, stage III and stage IV were 3 (2.3%), 32 (24.4%) and 96 (73.3%), respectively. There was statistical significance difference between TVS Tech-nique versus laparoscopy as regard detection of mid ante-rior adhesion, up anterior adhesion, up posterior adhesion, mid posterior adhesion, Rt-O-Ut adhesion, Inter O-O ad-hesion, Rt-O-side adhesion, Lt-O-Ut adhesion, Lt-O-side adhesion and Low posterior adhesion (P<0.05).
Conclusion: Adhesion scoring system could simply and noninvasively predict the degree of endometriosis adhe-sions. As a result, we could assess the actual condition of endometriotic adhesions with this approach both presur-gically and postoperatively.