Endometriosis surgery is normally indicated for women who are not responding to other forms of medical treatment. The most common form of endometriosis treatment is using drugs to control hormone levels, namely oestrogen, in a woman's body. Controlling the amount of oestrogen has a limiting effect on the growth of endometrial tissue.
Using hormone drugs does not always have the desired effect of limiting the growth of the endometriosis. In some women these drugs can also cause unwanted side effects or are contraindicated in women who are trying to get pregnant. Many women also manage their symptoms through the use of over the counter pain relievers and some have found that modifying their diet and lifestyle (healthy living and exercise) can also be beneficial.
When drug treatments and lifestyle changes no longer work many women turn to endometriosis surgery to help relieve the painful symptoms they suffer through every month. The most common surgical procedure for mild to moderate endometriosis is called Laparoscopy. It is a minimally invasive procedure in which a thin surgical instrument called a laparoscope is inserted through a small incision into the abdominal cavity.
In fact this procedure is the only way to confirm an endometriosis diagnosis through actually seeing the implants on the internal organs. Even then viewing the abdominal organs may not return an endometriosis diagnosis as the implants can be hidden from view or be too small to see.
The laparoscopic procedure is like any other surgical procedure and carries the same risks. It is normally done under general anaesthesia but in some cases it can be done with an epidural (spinal anaesthesia) allowing the woman to remain awake. A gynaecologist or surgeon will perform the procedure and anyone undergoing a surgical procedure will be advised to avoid eating or drinking eight hours before the procedure is scheduled.
Laparoscopic endometriosis surgery begins by inflating the patient's abdomen with either carbon dioxide or nitrous oxide gas. Inflating the abdomen moves the abdominal wall away from the internal organs and gives the surgeon a better view and more operating room.
A small quarter inch incision is then made usually just below the belly button. The laparoscope is then inserted into the abdomen and the surgeon can begin to examine the internal organs for signs of endometriosis. The laparoscope has a small camera and light on the end of it which the surgeon uses to view the abdominal cavity.
If endometrial or scar tissue is found the surgeon can insert additional instruments through small incisions to properly deal with the problem. There are several ways a surgeon can deal with endometriosis and scar tissue implanted on organs in the abdomen. Using different laparoscopic instruments he can remove tissue using small scissors and scalpels or use a laser or electro-cautery to burn away the offending tissue.
Once the surgery is complete the small incisions are stitched up with a few stitches. Because the incisions are so small there is generally no scarring. The whole procedure normally only takes 45 minutes to an hour and is usually done as an outpatient procedure.
Any pain or discomfort after laparoscopic endometriosis surgery is normally due to the inflation of the abdomen stretching the stomach muscles. Many women may also experience some discomfort in their shoulders due to the gas used to inflate the abdomen rising into the upper abdomen and passing through the shoulders as it escapes the body. The recovery time is normally a week before the patient is able to return to normal daily activities.
Most women experience significant pain relief after undergoing laparoscopic endometriosis surgery but there is no guarantee that the endometrial cells will not return over time. Of the women who have undergone this procedure over seventy percent have reported that their symptoms have lessened during the first few months after their procedure. Within a year of the surgery forty five percent of women report that they have some returning symptoms. Studies have shown that combining hormone therapy post-surgery can significantly reduce the symptoms of endometriosis by preventing the growth of new endometrial cells.
In very rare cases there can be complications from laparoscopic endometriosis surgery. These can include a pelvic infection, internal haemorrhaging that will necessitate opening up the abdomen to stop the bleeding, formation of scar tissue after surgery, and accidental damage to the internal abdominal organs.
Because endometriosis has no known cause medical research has been unable to find an actual cure. Endometriosis surgery, like hormone drug therapy and lifestyle changes, is a way of managing the painful symptoms it can cause. Women with endometriosis should talk to their gynaecologist about all the treatment options available to make an informed decision to properly manage this disease.