Surgery may be carried out to diagnose Endometriosis. If Endometriosis is seen, your specialist team may remove the Endometriosis at that moment, or they might plan to carry out a further operation with a more detailed plan.
Surgery may involve removing Endometriosis, separating organs held together by scar tissue or adhesions and removing cysts in the ovaries - whilst taking care to avoid causing further damage to the ovary and its function. This may also include removal of part of or all the affected tissue or organ.
Surgery may be recommended for several reasons, these may be:
When your symptoms are severe and medical treatments have not worked
When Endometriosis is stopping you from getting pregnant
When there is visible distortion of the pelvic organs or physical obstruction of the bowel, bladder or ureters (the tubes that carry urine from the kidneys to the bladder).
Can Endometriosis recur?
Endometriosis can recur post treatment. The rate of regrowth may depend on several factors, such as the severity of the condition, age, medical history, which organ is affected (to what extent), whether some areas of Endometriosis were missed or not appropriate to treat during previous surgery, and various other individual circumstances.
There are two types of operations
Conservative surgery refers to an operation where your surgeon performs a laparoscopy (keyhole surgery) to remove (excise) as much of the endometrial – like tissue, patches cysts and any other signs of Endometriosis you might have, whilst preserving (taking care of) your reproductive organs.
Complex surgery refers to those whose Endometriosis is more advanced and where other areas in the body are involved, such as the urinary bladder, the bowel, or the chest area (this is known as thoracic Endometriosis). This type of operation is usually carried out under the care of a multidisciplinary team, such as a gynaecologist working together with a urologist, colorectal, or thoracic surgeon where required.
What to expect from surgery
This procedure is usually performed under general anaesthetic, where gas is used to pump into the abdomen. This allows for surgeons to look inside for signs of Endometriosis using the laparoscope (a thin telescope-like instrument). If Endometriosis is seen, your surgeon will usually combine the diagnostic laparoscopy with an operative laparoscopy where usually up to three additional skin incisions are made.
This see and treat approach allows surgeons to not only identify areas affected by Endometriosis, but to remove it by either cutting away the Endometriosis or by using a laser or heat to destroy it. This type of surgery has advantages of avoiding large open wounds compared to the traditional laparotomy (open surgery). Other advantages include reduced scarring, shorter hospital stays and faster recover times.
A laparoscopy often allows the surgeon a better ability to visualise the pelvis than via open surgery.
There are however several ways this type of operation can be performed and sometimes, depending on the severity of the Endometriosis or any complications which may arise, treatment plans may be altered. Should the surgeon need different access then a laparotomy maybe required.
A Laparotomy (open surgery) is usually performed under general anaesthetic. This type of surgery may be carried out in instances such as when surgeons may require further access to the abdomen or when severe Endometriosis may be present in areas not able to be accessed via laparoscopy. This surgery involves creating a large incision (usually around 6 to 12 inches) either from the belly button down to the pubic bone, or across the knicker line.
There are some disadvantages of a laparotomy over laparoscopy. These can include scarring, higher risk of infection, and considerably longer recovery times and hospital stays. There are also post-op restrictions - patients are usually advised not to lift, bend, or take part in extensive workouts for a minimum of six weeks post laparotomy.
Experienced Endometriosis specialist doctors are usually able to perform most surgeries using the preferred laparoscopy method (key-hole surgery). However, at times a laparotomy maybe required even with an experienced Endometriosis team.
How long can recovery take?
Recovery can take anywhere between a few days and a few weeks, sometimes even months. This can really depend on each individual, their circumstances, and how invasive their surgery is. It is important to allow yourself time to rest and asking a family member, partner, or a friend to help take care of you could be useful, as you may experience post-operative pain and inflammation.
What happens after surgery?
After surgery, you should receive a follow up appointment with your medical team. It is here where your surgery will be discussed along with any further treatment plans and management should you need it.
It's important to know ...
Although surgery can help, relief is not always guaranteed. Endometriosis may also return post medical and surgical treatment. The rate of regrowth can depend on several factors, such as the severity of the condition, age, medical history, hormones, which organs are affected (to what extent), whether some areas of endometriosis were not removed during surgery, surgical complications, and various other individualised circumstances.
If your pain does not subside or if your symptoms persist, it’s important to tell your GP and medical team.
Are there risks associated with surgery?
There are risks associated with any surgery and general anaesthetic. If you and your medical team decide surgery is the best option for you, your specialist team should discuss the available treatments with you taking into consideration your age, your medical history, the severity of your symptoms, whether you’re looking to start a family, and various other individualised circumstances, along with any possible side effects, risks, and complications.