Laparoscopic Surgery for Endometriosis

Laparoscopic Surgery for Endometriosis

Surgery Overview

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large incision in the belly, the surgeon inserts a lighted viewing tool called a laparoscope through a small incision. If better access is needed, the surgeon makes one or two more small incisions for inserting other surgical tools.

If your doctor recommends a laparoscopy, it will be to:

  • View the internal organs to look for signs of endometriosis and other possible problems. This is the only way that the doctor can be sure that you have the condition. But a "no endometriosis" diagnosis is never certain. Growths (implants) can be tiny or hidden from the surgeon's view.
  • Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary (endometrioma), it is likely to be removed.

What To Expect

Laparoscopy is usually done at an outpatient facility. Sometimes a surgery requires a hospital stay of 1 day. You probably can return to your normal activities in 1 week, but it may take longer.

Why It Is Done

Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is most often used for checking and treating:

  • Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
  • Endometriosis pain that has continued or that came back after hormone therapy.
  • Severe endometriosis pain. (Some women and their doctors choose to skip medicine treatment.)
  • An endometriosis cyst on an ovary (endometrioma).
  • Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.

How Well It Works

Pain relief

As with hormone therapy, surgery relieves endometriosis pain for most women. But it doesn't guarantee long-lasting results. Some studies have shown that:

  • Most women—about 60 to 80 out of 100—report pain relief in the first months after surgery.footnote 1
  • More than 50 out of 100 women have symptoms return within 2 years after surgery. This number increases over time.footnote 2

Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.footnote 3

Infertility

If infertility is your primary concern, your doctor will probably use laparoscopy to look for and remove signs of endometriosis.

  • Research has not firmly proved that removing mild endometriosis improves fertility.footnote 1
  • For moderate to severe endometriosis, surgery will improve your chances of pregnancy.footnote 4
  • In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.

Endometrioma

There are various ways of surgically treating an endometrioma, such as draining it, cutting out part of it, or removing it completely (cystectomy). Any of these treatments brings pain relief for most women, but not all. Cystectomy is most likely to relieve pain for a longer time, prevent an endometrioma from growing back, and prevent the need for another surgery.footnote 1

Risks

Complications from the surgery are rare but include:

  • Pelvic infection.
  • Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
  • Scar tissue (adhesion) formation after surgery.
  • Damage to the bowel, bladder, or ureters (the small tubes that carry urine from the kidneys to the bladder).

References

Citations

  1. American College of Obstetricians and Gynecologists (2010). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
  2. Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
  3. Ferrero S, et al. (2010). Endometriosis, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  4. American Society for Reproductive Medicine (2012). Endometriosis and infertility: A committee opinion. Fertility and Sterility, 98(3): 591–598.

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