Endometriosis is a condition where tissue similar to the endometrium (that lines the inside of the uterus) also grows outside the uterus.
Successful surgical treatment may be able to delay or stop the progress of the condition.
The objectives of surgery are:
Surgery may be recommended to:
Laparoscopy is usually preferred to an open operation through a larger incision (laparotomy) because:
Laparoscopy is usually performed under general anaesthesia. In some cases, either spinal or epidural anaesthesia may be recommended. Modern anaesthesia is safe and effective, but does have risks. Rarely, side effects from an anaesthetic can be life threatening. Your anaesthetist can explain the anaesthetic procedure in greater detail.
A diagnostic laparoscopy is undertaken solely for the purpose of diagnosis with no surgical treatment. A small piece of tissue of any suspected endometriosis patch can be removed (biopsied) for examination by a pathologist. This can confirm the diagnosis of endometriosis.
Operative laparoscopy is undertaken to surgically treat patches. It is often done at the same time as diagnostic laparoscopy, or soon after diagnosis, or as a stage-two procedure. Sometimes it can only be performed after an initial diagnostic laparoscopy to assess the severity of the condition. Before surgery, you may need a “bowel preparation” to empty the bowel.
The surgeon will try to remove as much endometriosis as possible. A variety of techniques may be used (depending on the surgeon’s preference), including:
Occasionally, the surgeon may need to make a larger cut in the abdomen, called a laparotomy; a very small incision is called a mini-laparotomy. Laparotomy may be required in women who have had many operations in the past, or those with an “up and down” cut on their tummy. The decision to make larger cuts is made either to allow more complete removal of the endometriosis or for the patient’s safety.
Depending on the extent of the surgery, the woman is often able to go home the same day as the procedure.
If you have had general anaesthetic, do not drive for at least 24 hours, and do not make any important decisions for two days. Although a few women feel able to return to work the next day, most take a few days off work.
Shower and bathe as normal. Tampons may be used and changed regularly.
After the operation, some symptoms may persist for several days, including:
Your gynaecologist will prescribe a painkiller for you. If you have persistent discomfort and pain, tell your gynaecologist.
Normal physical and sexual activity can be resumed after any bleeding and discomfort have stopped, and when you are feeling well enough.
Constipation after abdominal surgery commonly occurs. This is especially so if endometriosis was present on the bowel and if codeine or pethidine is taken for pain relief. To assist return to normal bowel habits, eat a lighter diet with plenty of fruit, have a high fluid intake, and do gentle exercise, such as walking. The addition of a teaspoon of psyllium (available from pharmacies) also helps.