Endometriosis

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:

• 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

A diagnostic procedure 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 surgery 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.

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.