surgery for endometriosis

Endometriosis is a disease that results in the abnormal growth of endometrial cells in locations outside the uterus. This tissue build-up usually occurs on the walls of the pelvis and can occur on the ovaries and the fallopian tubes. However, endometrial implants can occur in other areas such as the vagina, the urinary tract and the gastrointestinal system. Scar tissue, adhesions, and structural abnormalities can develop resulting in infertility.

Endometriosis may be treated with hormones, although the hormones can act as contraceptives. Therefore, many women attempting to conceive choose to treat endometriosis surgically, often in combination with fertility therapy.

• laparoscopy
• laparotomy

laparoscopy

A surgical procedure called a laparoscopy is most commonly used to aggressively remove endometrial implants and adhesions. A small incision is made beneath the navel and a thin fiber-optic scope is inserted to examine the pelvic area. The affected tissue is then removed, through microsurgery or by laser surgery.

A laser (the term stands for “light amplified stimulation emission radiation”) is an intensified single frequency of light that allows the cutting, cauterizing or vaporizing of tissue. The surgeon, who must be specifically trained in performing laser surgery, uses the laser like a scalpel. Surgical lasers are designed to treat the damaged tissue while minimizing any chance of harm to surrounding healthy tissue. Laparoscopic laser surgery is a minimally invasive procedure from which most patients fully recover within just a few days.

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laparotomy

In severe cases involving extensive lesions or scarring, especially around the bowel or bladder, endometriosis may be treated through a more invasive and costly surgical procedure called a laparotomy. A laparotomy, also performed under general anesthesia, requires a wide abdominal incision and conventional surgical instruments are used. The recovery period for this major surgery is about six to eight weeks.

The available research is controversial; however, some studies have shown an increase in pregnancy rates in women who have had surgical treatment for endometriosis.

When the pain of endometriosis is the primary concern, surgical procedures such as a uteral sacral nerve ablation (severing the nerves to the uterus to reduce pain) or a presacral neurectomy (severing sensory nerves leading to the pelvis) can be performed.

Endometriosis often recurs over time, even after successful surgery. When a woman no longer wants to conceive, a hysterectomy with removal of the ovaries may be recommended in order to permanently treat the condition.

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