Surgery for Endometriosis

Surgery for Endometriosis

Endometriosis is a condition in which the type of tissue that lines a woman’s uterus grows outside it. A surgery called laparoscopy is the only way to know for sure whether you have it.

Your doctor might also recommend surgery if you have severe endometriosis pain and medication doesn’t help enough. They can find the endometriosis inside your body and take out all or some of the affected tissue.

There are some things to think about, including whether you want to get pregnant later. You might not be able to have children after certain endometriosis operations. Talk with your doctor about what options are a good fit for you.

Laparoscopy Surgery for Endometriosis:

Doctors can diagnose and treat endometriosis with a laparoscopy, which uses a thin tube called a laparoscope. It has a light and a camera that let your doctor see inside your body. Before a laparoscopy, you’ll get general anesthesia, medication to put you to sleep. Your doctor will make a small cut in your bellybutton or another part of your abdomen. They’ll inflate your belly with gas so the camera can get a clear view. The laparoscope will go in through that cut. Your doctor might need to make more small cuts for other tools. This procedure could take from 30 minutes to 6 hours, depending on how severe your case is. After your doctor checks for endometriosis and/or removes tissue, they’ll take out the instruments and gas, and they’ll close the cuts. You’ll stay in a recovery area until the anesthesia wears off. It might make you sleepy and nauseated. Laparoscopy is usually an outpatient procedure, meaning you can go home the same day.

Laparotomy Surgery for Endometriosis:

A laparotomy is major surgery, with one large cut in your belly. Doctors usually use it when you have severe endometriosis that they can’t treat with laparoscopy. As with laparoscopy, you’ll get medicine to put you to sleep. Your doctor will cut through your skin and muscle so they can see into your abdomen and take out affected tissue. After the surgery, your doctor will close the cut and move you to a recovery area. You’ll probably have to stay in the hospital for at least one night.

Hysterectomy for Endometriosis:

Your doctor may need to take out some or all of your reproductive organs if they’re damaged or if they have endometriosis tissue on them. The removal of your uterus is called a hysterectomy. An oophorectomy is when they take out your ovaries. Your doctor will talk with you before the surgery about whether they might need to take this step, and they’ll do it only if you’ve agreed to it. Doctors may recommend a hysterectomy for women whose symptoms don’t go away despite other treatments and who don’t plan to have children down the road. Your doctor can usually do a hysterectomy with a laparoscopy, but they can also do it with a laparotomy or by taking out the organs through your vaginal opening.

Purpose

Endometriosis causes tissue that normally grows on the inside lining of your uterus (endometrium) to implant in other parts of your abdomen.

This misplaced tissue can cause symptoms like pain that can occur during your period, sexual intercourse, or bowel movements. Having endometriosis can also make it harder for you to get pregnant.

When it comes to treating your endometriosis, your doctor might recommend surgery if:

  • You have severe pain: Because the endometrium is growing where it doesn’t belong, endometriosis can impact surrounding tissues, leading to pain and inflammation. Sometimes pain can be severe and significantly interfere with your daily activities.
  • Medications haven’t helped: Hormone therapy and pain medications can often help to relieve symptoms in some stages of endometriosis. However, some stages of endometriosis don’t respond well to medications.
  • You’ve been trying to get pregnant: Endometriosis can cause damage to sperm and eggs. In severe cases, scar tissue from endometriosis can block the fallopian tubes. This can make it harder for someone with endometriosis to conceive.

Talk over all of your options with your doctor. Weigh the pros and cons of each one. It’s also helpful to get a second opinion.

Preparation and Procedure

A surgeon will often give a woman specific instructions on how to prepare for surgery. These may include:

  • Planning for someone to pick them up from the hospital and stay with them for 24 hours
  • Planning for someone to pick them up from the hospital and stay with them for 24 hours
  • Refraining from smoking in the days or weeks leading up to the surgery
  • Avoiding taking certain medications the day of surgery, if the doctor recommends it

Sometimes a doctor will recommend using a special soap in the shower or cleansing wipes on the abdomen the night before or day of the surgery to help to prevent infections. A person may not be able to shower or bathe for 48 hours following the surgery, so they may wish to shower just before going to the hospital. Doctors may also order a bowel preparation or “bowel prep,” which involves taking medications to empty the bowel. Bowel prep can be an unpleasant part of preparing for surgery but helps a doctor safely remove endometriosis lesions from the gastrointestinal tract.

A nurse or other healthcare professional will provide a hospital gown and compression stockings. These tight socks will help prevent deep vein thrombosis (DVT). A nurse will start an intravenous (IV) line in the person’s hand, which the anaesthesiologist will use later to administer the anesthesia. The surgeon and nurse will be present before the surgery to answer any questions and discuss the risks and benefits of the procedure. Surgeons perform laparoscopies using general anesthesia, meaning the individual is completely asleep and unaware of the procedure. An anaesthesiologist will provide medications and monitor the person’s vital signs during the entire procedure. The surgeon will make small incisions in the person’s abdomen, including near or in the navel to minimize scarring. The surgeon will then insert an instrument that allows them to fill the abdomen with carbon dioxide gas. Inflating the abdomen with gas helps the surgeon see the pelvic organs. A doctor may then make further incisions and insert instruments as needed to identify possible areas of endometriosis and remove samples for biopsy or as a treatment. After the operation, the surgeons will remove the instruments and close the incisions, using either stitches or glue. They will then cover these incisions with bandages or other dressings.

Innovations in surgical approaches mean that doctors may use an operating robot to perform the procedure.

Risks

Complications of endometriosis surgery are rare. They include:

    • Damage to organs like your bladder or intestines

 

  • Infection
  • Bleeding
  • Trouble peeing (this is usually short-term)
  • An unusual connection between your vagina and another organ, such as your intestines (fistula)
  • Scar tissue that can cause belly pain or bowel blockages

 

Recovery

You’ll recover faster after laparoscopic surgery than after a laparotomy. Regardless of the type of procedure you’ve had, your activities will be limited for the first couple of days or weeks after your procedure. You may feel well recovered following a laparoscopy (without hysterectomy) in 1 to 2 days but may need more time before resuming normal activities.

Meanwhile, recovery from a laparoscopic or vaginal hysterectomy can take 3 to 4 weeks. A full recovery from an abdominal hysterectomy can take 4 to 6 weeks.

It’s very important to talk with your doctor about when you can go back to activities such as driving, working, and exercising. Carefully following their directions can help to promote a smooth recovery.

Pain or discomfort is common following any surgery. Your doctor will prescribe you medications to help manage this in the days after your procedure. Additionally, your doctor may prescribe hormone medications to help prevent endometriosis pain from recurring in the future.

After a laparoscopic procedure, you may have shoulder or back pain. This is caused by gas trapped in your belly. The pain should go away within a few hours or days.

After a hysterectomy, you’ll no longer get a period. If you had your ovaries removed, you might begin menopause if you don’t start hormone replacement therapy. This means you may experience the effects of menopause, like hot flashes, vaginal dryness, and bone density loss.

It’s also not uncommon for some who’ve had a hysterectomy to feel depressed or have a sense of loss at not being able to have children. It’s important to talk to your doctor about how to manage the physical and emotional symptoms that can follow a hysterectomy.

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