Endometriosis

Endometriosis is a condition where tissue similar to the endometrium (that lines the inside of the uterus) also grows outside the uterus.

Principles of Surgical Treatment

Successful surgical treatment may be able to delay or stop the progress of the condition.
The objectives of surgery are:

  • To diagnose whether endometriosis is present, and
  • To remove or destroy patches as completely as possible from the pelvic organs.

Surgery may be recommended to:

  • Treat pain and discomfort that have not been adequately controlled with medical therapy
  • Improve fertility, which can be diminished by endometriosis
  • Remove an endometrioma (chocolate cyst) from an ovary
  • Remove other areas of endometriosis and preserve fertility as much as possible.

Laparoscopy is usually preferred to an open operation through a larger incision (laparotomy) because:

  • Laparoscopy reduces the risk of adhesions (strands of scar tissue that can stick to pelvic organs)
  • The laparoscope provides excellent close-up views of patches (if present)
  • Incisions are smaller and less painful during healing, with a better cosmetic result
  • Recovery time is faster.

Anaesthesia

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.

Laparoscopic Procedures to Diagnose and Treat Endometriosis

Diagnostic laparoscopy

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

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:

  • Excisional surgery (removal of patches using small cutting instruments)
  • Cautery (cutting and burning of tissue using an electrical probe)
  • Laser surgery, for excision or cautery.

Laparotomy

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.

Recovery after Laparoscopy

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:

  • Substantial pain and discomfort at the site of the incisions and around the operated area
  • Muscle aches and pains, and tiredness
  • Mild nausea
  • Painful cramps
  • Vaginal bleeding, if an instrument was placed in the uterus
  • A sensation of swelling in the abdomen
  • Pain in one or both of the shoulders that may extend into the neck. This is thought to be due to the carbon dioxide gas used during the procedure. The pain may last for a few days. Lying down may help to improve it.

Pain Relief

Your gynaecologist will prescribe a painkiller for you. If you have persistent discomfort and pain, tell your gynaecologist.

Resumption of Activities

Normal physical and sexual activity can be resumed after any bleeding and discomfort have stopped, and when you are feeling well enough.

Constipation

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.