Surgical treatment for Endometriosis

This procedure involves the insertion of a thin telescope into the abdomen to examine the pelvic organs. A 1cm incision is made either within or under the umbilicus, and the abdomen is filled with gas to facilitate distension. This distension enables the surgeon to scrutinize the pelvic organs for confirmation of endometriosis diagnosis. Another small incision is then made, either close to the pubic hairline or on the side of the abdomen.

If endometriosis is detected, one or two additional incisions may be made to facilitate the treatment of affected areas. The surgeon may opt to either cauterize or remove the affected regions.

Prior to surgery, you may be required to take medications. If the tissue exhibits high vascularity, your surgery might involve partial treatment, followed by drugs and a second planned procedure. In essence, the surgery could be conducted in two stages to ensure the optimal and complete removal of the disease.

If keyhole surgery and other treatments prove ineffective, and you are not considering pregnancy, the option of a hysterectomy, or removal of the womb, may be considered.

It's important to note that a hysterectomy is a major operation with significant impacts on the body. The decision to undergo a hysterectomy is substantial and should be thoroughly discussed with your GP or gynaecologist.

It's crucial to understand that hysterectomies are irreversible, and although unlikely, there is a possibility that endometriosis symptoms could return after the procedure. If the ovaries and cervix are retained, there is a higher likelihood of pain from endometriosis recurring.

If ovaries are removed during a hysterectomy, the potential need for hormone replacement therapy (HRT) afterward should be discussed. However, the optimal course of HRT for women with endometriosis is not clear. For instance, oestrogen-only HRT may lead to a return of symptoms if any endometriosis patches remain. This risk can be mitigated with a combined course of HRT (oestrogen and progesterone), although it is associated with a small increase in the risk of developing breast cancer. Careful consideration and consultation with medical professionals are crucial in making informed decisions about hysterectomy and postoperative hormone therapy.

The risk of a major complication from a standard laparoscopy is approximately 1 to 2 per 1000 cases. However, in the case of the most complex form of laparoscopic surgery for endometriosis, the risk can be as high as 1 in 10 cases. It's important to note that all the potential risks mentioned below will be thoroughly discussed by members of the surgical team when you are asked to sign the consent form for the operation:

• Damage to bladder and ureters
• If the ureters are involved then a stent (tube) is passed via a telescope. This is removed as a day case 6 weeks later
• Damage to bowel. This can be in the form of a leak from the join leading to an abscess. This may require draining with a small tube, occasionally it will require a larger cut in the abdomen to correct the problem
• Damage to nerves and blood vessels
• Infection
• Risk to delayed complications including bowel leak and haematoma (collection of blood in the abdomen) that can occur up to 2 weeks after the procedure. In addition, if a piece of bowel has had to be removed then there may be changes to the way the bowels work in the future. These changes usually resolve over a period of weeks to months
• Risk of a fistula (abnormal connection between the bowel (or other organ) and the vagina)
• Loss of a tube or ovary due to bleeding
• Risk of adhesion formation