Advanced endometriosis surgery
Am I candidate for surgery?
You may be considered for surgery to treat endometriosis if you
- Suffer from severe pain that is not relieved with conservative methods
- Suffer from infertility because of endometriosis and decide to get pregnant
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:
- If the endometriosis lesion is small, it can be shaved off, leaving the bowel intact.
- A circular section of the bowel containing the endometriosis can be cut and the resulting hole closed.
- For deeper endometriosis, a section or segment of affected bowel is excised and the remaining sections of the bowel are re-joined.
- In case of complications such as leakage at the region of the bowel that is re-joined, a process called colostomy may be performed temporarily, where the excised end of the colon is diverted to an opening created in the abdominal wall.
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:
- Smaller incisions
- Less post-operative pain and discomfort
- Faster recovery
- Shorter hospital stay
- Earlier return to normal activities
- Smaller scars
- Minimal internal scarring
- Provides a definite diagnosis
- Ascertains long-term relief in 70% of women
- Does not require long-term use of medication
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:
- Longer recovery
- More post-operative pain
- Larger scar formation when compared to laparoscopy
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.
What are the outcomes of endometriosis surgery?
Surgery cannot cure endometriosis. It can offer significant but short-term pain relief. However, removal of deep endometriosis tissue can lead to long-term pain relief.
What are the potential complications of endometriosis treatment?
As with most treatments, the various treatments for endometriosis can be associated with certain side effects and complications such as:
- Endometriosis medication can cause side effects such as bleeding, bloating, nausea, skin changes, elevation in BP, weight gain and depression.
- Surgery can be associated with complications such as damage to nearby organs or large blood vessels, infection, bleeding or blood clots.
What is the prognosis of endometriosis treatment?
Endometriosis treatment cannot completely cure endometriosis, but long-term prognosis of endometriosis treatment should consider three important parameters:
- Management of symptoms
- Rate of recurrence
- Achievement of pregnancy
Endometriosis can recur, necessitating repeat surgery or management with hormone therapy. However, most patients can experience a good quality of life and conceive with treatment. In some cases, you may have to consider IVF to help you get pregnant.
What is the cost of endometriosis surgery?
Any costs involved will be discussed with you prior to your surgery.
What is the likelihood of endometriosis recurrence? How can it be managed?
While surgery is effective in alleviating pain, endometriosis can recur 40% of the time after conservative surgery. Thus, ongoing medical treatment is recommended. The chance of recurrence is more in severe cases.
How can endometriosis be prevented?
Since the exact cause of endometriosis is not certain, it is not clear how the condition can be prevented.
What are the lifestyle recommendations to manage pain related to endometriosis?
Regular exercise, relaxation, rest, meditation, hot water bottle, warm baths and eating healthy to prevent constipation can help relieve pelvic cramping and pain.
What is the current research regarding endometriosis treatment?
Extensive research is being done to find better treatment options for endometriosis. Some of the recent studies are listed below:
- Aznaurova YB, Zhumataev MB, Roberts TK, Aliper AM, Zhavoronkov AA. Molecular aspects of development and regulation of endometriosis. Reprod Biol Endocrinol. 2014; 12: 50.
- Morotti M, Vincent K, Brawn J, Zondervan KT, Becker CM. Peripheral changes in endometriosis-associated pain. Hum Reprod Update. 2014 Sep-Oct; 20(5): 717736.
- Hughes CL, Foster WG, Agarwal SK. The Impact of Endometriosis across the Lifespan of Women: Foreseeable Research and Therapeutic Prospects. Biomed Res Int. 2015; 2015: 158490.