Am I candidate for surgery?
You may be considered for surgery to treat endometriosis if you
What are the indications of the different types of surgeries?
Your surgeon will consider conservative surgery when you wish to get pregnant in the future. Laparoscopy is usually the first approach considered for conservative surgery. Laparotomy is suggested only if the endometriosis is extensive, severe and the anatomy is distorted as some of the organs get stuck together.
Radical surgery on the other hand is performed in severe cases, when you do not wish to have any children.
How do I prepare for surgery?
Before endometriosis surgery, you will be advised not to eat or drink anything for six hours prior to your procedure. You may be given a solution to drink to clear your bowels.
How is surgery performed?
Surgery can be performed by the following methods:
The laparoscopic procedure when performed for diagnosis can be continued to treat the endometriosis as well. This is a minimally invasive surgery that is performed with the help of a laparoscope, which is a thin long lighted tube with a camera attached. The laparoscope can be inserted at the surgical site through a tiny incision made on your skin. The images captured on the camera can be relayed on a large monitor for your surgeon to view. A harmless gas is injected to inflate the abdomen, allowing for a clear view of the organs.
Two more small incisions are made to allow the insertion of other surgical instruments such as a laser to excise or cauterise the endometrial implants (destroy with intense heat and seal off the blood vessels). Scar tissue may also be removed. Your surgeon ensures that the surrounding healthy organs are not harmed.
This involves the removal of the endometriosis tissue through a long incision made along the bikini line. It is more invasive than the laparoscopic procedure. Sometimes, a laparoscopic procedure gets converted into a laparotomy in the event of a surgical complication.
Hysterectomy is a radical surgery that involves the removal of the uterus. Oophorectomy is a radical surgery that involves the removal of the ovaries.
Bowel resection is performed if the bowel has also developed endometriotic adhesions. Your surgeon may perform one of three depending on your condition:
Depending on the recurrence of endometriosis, you may require repeat surgeries.
What are the advantages and disadvantages of the different types of treatments?
While hormonal therapy can help easily relieve pain, many may not help you become pregnant and may be associated with side effects such as acne, cramps, hot flushes, mood swings and weight gain.
When considering surgery for the treatment of endometriosis, the minimally invasive laparoscopic procedure is associated with certain procedure-related advantages such as:
However, it may not be useful to treat all forms of endometriosis and it has a recurrence rate of 30%.
Laparotomy may be able to treat more extensive endometriosis and related complications but is associated with risks and complications of an open surgery and disadvantages such as:
Hysterectomy helps achieve a 90% cure long-term, without the need for medications, but the biggest disadvantage is the inability to achieve pregnancy. You may also need hormone replacement therapy if your ovaries are also removed.