Endometriosis Surgery

When is Endometriosis Surgery Required?

The surgical treatment to cure endometriosis is required when the routine hormonal medications fail to cure the symptoms, affect the surrounding organs, or when there are issues of fertility.

See your gynaecologist if you notice any of the following symptoms:

• Severe pelvic pain
• Painful periods
• Pain during intercourse
• Difficulty conceiving

What Medical Conditions Necessitate Endometriosis Surgery?

The following health conditions require endometriosis surgery:

• Endometriomas where large, fluid-filled cysts are formed on the ovaries, and the endometrial tissue grows there.
• Deep infiltrating endometriosis is when endometrial tissue grows deep into the walls of pelvic organs, most often the bladder, bowel, or the space between the uterus and rectum.
• Infertility happens when scarring and inflammation block the fallopian tubes, damage eggs, or distort the anatomy so that conception is impossible.
• Severe endometriosis stages 3 or 4 disease, with extensive scarring (adhesions) and significant distortion of anatomy.

What Does Laparoscopic Surgery Do for Endometriosis?

The gynaec-laparoscopic surgeon will perform the minimally invasive procedure to treat the problem-causing endometriosis. They make small cuts and use a high-def camera to be precise while removing the endometriosis tissue while preserving healthy organs whenever possible.

What are The Types of Endometriosis Surgery?

Here are the various types of laparoscopic endometriosis surgery:

• Laparoscopic Excision Surgery: It involves the complete removal of endometriosis lesions and sending them to the laboratory for histological analysis. This is diagnostic and often the treatment of choice for long-term relief of symptoms.
• Laparoscopic Ablation: It is the destruction of the endometriosis lesions using heat or laser energy. This method does not leave the tissue for histological testing.
• Ovarian Endometrioma (Chocolate Cyst) Removal: It involves the cystectomy (ovarian chocolate cysts) from the ovaries while preserving ovarian tissue whenever possible.
• Complex Endometriosis Surgery: This surgery may require a multidisciplinary team combining gynaecologists with colorectal and urological surgeons. It is performed only when the uterine growths invade the surrounding bowel and bladder.

What are the Benefits of Laparoscopic Endometriosis Surgery?

The surgery is simple, minimally invasive, and has the following benefits:

• Less pain
• Smaller scars
• Reduced blood loss
• Shorter hospital stay and faster recovery
• Earlier return to daily activities
• Better quality of life
• Reduced progression of disease
• Improved pelvic organ function

How is Laparoscopic Endometriosis Surgery Performed?

The laparoscopic gynaecologist surgeon will perform the endometriosis surgery. Typically, it follows the steps mentioned below:

• They will administer general anesthesia and closely monitor the vitals. You will completely remain pain-free and are completely asleep.
• The surgeon will make smaller abdominal incisions near the belly button, inflate the abdomen, and insert the specialized tool called the laparoscope.
• The laparoscope has a camera on one end, and it will help the surgeon identify the endometriosis lesions. They will remove lesions, cysts, and adhesions by either excising or ablating them.
• The laparoscope will then be taken out, and the small cuts will be stitched up.

How Long Does Recovery Take After Laparoscopic Endometriosis Surgery?

Recovery after laparoscopic surgery is easy and depends on the surgical complexity. These steps will give you better results:

• You will be in the hospital for a short stay (1-2 days) and back to your normal activities in 1-2 weeks.
• Full healing in 4-8 weeks expected. Take the pain medicine and antibiotics that are recommended for a few days.
• Expect slight shoulder pain because of the gas inflated during the procedure.
• For the first few weeks, avoid heavy lifting, strenuous physical exercise, and sexual intercourse.
• Rely on a healthy, balanced diet and attend the scheduled follow-ups.

Does Endometriosis Recur After Surgery?

Endometriosis may recur in some women after the surgical removal. The doctor will remove the existing lesions, and small, non-pigmented microscopic lesions left behind may grow and cause pain over time. Doctors recommend medical management of endometriosis following the surgical removal. Intraoral contraceptives, progestins, and hormonal IUDs are prescribed if the patient is not actively trying to conceive. Regular follow-up is very important to monitor

Will Endometriosis Surgery Help with Fertility?

Getting endometriosis surgery will generally improve the chances of fertility. Removal of the scar tissue clears the blocked fallopian tubules and addresses the large ovarian cysts. However, some patients would require removal of ovarian tissue, reducing the egg reserve. This is the reason for the gynaecologist carefully measuring the benefits and risks against factors such as age, overall health, and disease stage.

How Long Does Endometriosis Surgery Take?

Laparoscopic endometriosis surgery can take anywhere between 1 and 3 hours. Some complex scar tissues may require up to 6 hours. The duration of treatment varies with the surgeon’s experience, the degree of the illness, and the general health of the patient.

Can I Get Pregnant After Endometriosis Surgery?

Yes. In fact, the endometrial tissue is surgically removed, which removes some physical blockages. This increases the chances of becoming pregnant. But the quality of the eggs and the quality of the partner’s sperm also matter for the odds of conceiving.

Is the Surgery Painful?

You don’t feel any pain during the laparoscopic endometriosis surgery because it is performed under general anesthesia. Expect a slight dull ache near the incisions during recovery. Follow the mentioned recovery steps and use the prescribed painkillers. The pain and discomfort subside slowly.

Will I Have Visible Scars?

Laparoscopic surgery for endometriosis results in tiny, barely visible scars. They are small, round, dot-like, or 0.5 to 1 cm long. The visibility of scars depends on the skin type. For instance, your skin is more prone to keloid scars; the incisions may heal, leaving slightly noticeable scars.

When Should I Consult a Gynecologist?

Attend the routine follow-up check-up after endometriosis surgery. This will help the surgeon monitor the recovery rate. Don’t ignore the signs of bleeding, infection, pus discharge, and chronic pelvic pain. See your doctor immediately. Always remember, the earlier you act, the better the outcomes will be.