Endometriosis Surgery

What is Endometriosis Surgery? 

Endometriosis surgery is a medical procedure to treat endometriosis, a painful disorder in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. The surgery is aimed to remove these endometrial growths or implants and relieve symptoms.


Who is Suitable for Endometriosis Surgery?

Endometriosis surgery might be considered suitable for the following patients:

  • Pain symptoms: Women experiencing severe pain symptoms that are not managed effectively with medication may be candidates for surgery.
  • Fertility concerns: If endometriosis is causing infertility, surgery might be recommended to improve the chances of conception.
  • Growth of endometrial tissue: Surgery might be recommended if endometrial tissue continues to grow or spread after trying hormonal treatments or if large cysts form (endometriomas).
  • Severe adhesions: If the endometriosis has caused severe scar tissue or adhesions, surgery may be required to remove them.


While surgery can effectively treat endometriosis and improve symptoms, it does not cure the disease, and symptoms may return over time. The decision to have surgery should be discussed thoroughly with a gynaecologist to understand the potential benefits and risks.


Benefits of Endometriosis Surgery

  • Pain relief: Surgery can remove endometriotic lesions, cysts, and adhesions, significantly reducing pain symptoms associated with endometriosis, including pelvic pain, painful periods, and pain during sexual intercourse.
  • Improved fertility: In some cases, surgery can improve fertility, especially when endometriosis is the primary cause of infertility. The reproductive organs can function more normally by removing endometriotic implants and adhesions.
  • Diagnosis and disease staging: Surgery, particularly laparoscopy, allows for a definitive diagnosis of endometriosis, as it allows the surgeon to visualise the organs and take biopsy samples if needed. It also helps in staging the disease, which can guide future treatment.
  • Treatment of severe cases: In severe cases of endometriosis where other treatments have failed, surgery may provide the most effective way to manage the condition.
  • Prevention of disease progression: By removing endometriotic implants, surgery can help to prevent further spread or worsening of the disease.


Types of Endometriosis Surgery

  • Laparoscopy: This minimally invasive procedure is often used to diagnose and treat endometriosis. The surgeon makes small incisions in the abdomen to insert a laparoscope and other surgical instruments.
  • Laparotomy: This is a more invasive procedure that involves a large incision in the abdomen. The surgeon has a wider view of the organs and can remove endometriotic lesions. This method is typically used for more severe cases or when laparoscopy is unsuitable.
  • Hysterectomy: This involves the surgical removal of the uterus, and in some cases, the cervix, ovaries, and fallopian tubes may also be removed. This procedure is typically considered a last resort when all other treatments have failed and the patient does not wish to preserve fertility.
  • Excision Surgery: In this procedure, the surgeon cuts out endometriosis implants down to their roots. This has the advantage of completely removing the lesions but requires a skilled surgeon to prevent damage to surrounding tissues.


Alternative Options to Endometriosis Surgery

Medical treatments may be offered to patients with chronic pain or endometriosis. Although using these medical treatments as first-line therapies to relieve symptoms is reasonable, none can remove endometriosis. The symptoms and disease will return once the woman stops using the medication. These treatments are usually:

  • Simple analgesics - common ones are Panadol, Endone, Napropen, Ibuprofen
  • Hormone treatments – e.g. oral contraceptive pill
  • Mirena - a special intrauterine device that slowly releases a hormone called levonorgestrel


Hormonal treatments or Mirena are unsuitable for women trying to get pregnant.


Endometriosis Laparoscopic Surgery

The most effective way to remove endometriosis is with laparoscopic (keyhole) surgery. The high-definition, magnifying camera in laparoscopy (called a laparoscope) allows doctors to have an accurate view of pelvic structures and identify endometriosis. The sophisticated, dedicated laparoscopic devices are also ideal for precisely removing endometriosis around pelvic organs.

Laparoscopic surgery is generally preferred over more invasive procedures, such as laparotomy, due to its lower risks, shorter hospital stay, and quicker recovery time.


Preparation for Endometriosis Laparoscopic Surgery

If you're scheduled to undergo laparoscopic surgery for endometriosis, here are some general steps you may need to take:

  • Medical History Review and Physical Examination
  • Preoperative Testing, such as blood tests, urinalysis, and possibly imaging studies
  • Medication Review
  • Fasting
  • Bowel Preparation
  • Arranging for Help After Surgery


Endometriosis Laparoscopic Surgery Procedure

Here's a general outline of what happens during laparoscopic surgery for endometriosis:

  • You'll be given anaesthesia during the procedure to keep you asleep and pain-free. This is usually general anaesthesia, which means you'll be unconscious.
  • The surgeon will make one or more small incisions (usually around 1/2 inch) in your abdomen.
  • A thin tube with a camera (laparoscope) is inserted through one of the incisions. The abdomen is inflated with a harmless gas (usually carbon dioxide) to give the surgeon a better view and more room to work.
  • The surgeon uses the laparoscope to explore the abdomen and pelvis, looking for endometrial implants.
  • If endometrial implants are found, the surgeon will remove or destroy them. This is usually done using small surgical instruments inserted through the incisions. The tissue can be removed (excised) or destroyed using laser or heat (ablation) methods.
  • Once the procedure is finished, the instruments are removed, the gas is released from the abdomen, and the incisions are closed with sutures or staples.


After Endometriosis Laparoscopic Surgery

Immediately after surgery, you'll be taken to a recovery room, where gynaecologists will monitor your vital signs as you wake up from the anaesthesia.


Endometriosis Laparoscopic Surgery Recovery

Recovery from laparoscopic surgery for endometriosis is generally quicker and involves less discomfort than recovery from open abdominal surgery, but it still requires time and care. Here's a general outline of a recovery plan:

  • Rest and Activity: Rest is crucial for the first few days after surgery. Gradually, as you feel better, you can increase your activity level. Walking is encouraged to help prevent blood clots.
  • Pain Management: You'll likely have some pain after the procedure. This can be managed with medications prescribed by your doctor. A heating pad may also help to relieve discomfort.
  • Wound Care: You'll need to keep your incisions clean and dry. Your doctor will give you specific instructions on how to care for your wounds.
  • Diet: You can usually return to your normal diet after surgery, but some people may experience nausea or constipation from the anaesthesia or pain medications. Drinking plenty of fluids and eating a diet high in fibre can help manage these symptoms.
  • Follow-up Appointments: You'll likely have a follow-up appointment with your doctor a week or two after surgery to check your recovery, discuss any pathology results, and plan further treatment if needed.
  • Returning to Work: Depending on the nature of your job, you can return to work within one to two weeks after surgery.


Endometriosis Laparoscopic Surgery Prognosis

Laparoscopic surgery for endometriosis often relieves symptoms, especially pain, and can improve fertility. 


Endometriosis can sometimes recur after surgery, and additional treatment may be needed. This could be further surgery or medical management with hormonal therapies. The risk of recurrence is lower if all of the endometriosis is removed during the initial surgery.


For some women, symptoms can be managed effectively with hormonal therapies after surgery; for others, lifestyle changes such as diet and exercise can also help manage symptoms.


Discussing your prognosis and long-term management plan with your gynaecologist is important to ensure you clearly understand what to expect after surgery.


Endometriosis Laparoscopic Surgery Risks

Some potential risks and complications associated with this procedure include:

  • Bleeding and Blood Clots
  • Infection
  • Damage to Other Organs
  • Anaesthesia Risks
  • Adhesions
  • Recurrence of Endometriosis
  • Negative Impact on Fertility


Delaying Endometriosis Laparoscopic Surgery

In some cases, delaying surgery might lead to the following:

  • Worsening symptoms: The pain and discomfort associated with endometriosis could worsen if the condition is not treated.
  • Progression of the disease: Endometriosis is a progressive condition that could continue to spread if not treated.
  • Potential impact on fertility: If endometriosis affects fertility, delaying treatment could make it more difficult to conceive.


However, it's also important to note that surgery is just one of several treatment options for endometriosis. Symptoms can be managed effectively with hormonal therapies, pain medications, and lifestyle changes. 


The decision to have surgery should be based on a thorough discussion of the potential benefits, risks, and alternatives with a gynaecologist.

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