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Endometriosis Surgery

Reviewed by Neha Pathak, MD on January 11, 2021

Why Is Endometriosis Surgery Done?

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.

When Is It Time for Endometriosis Surgery?

Whether you should have surgery may depend on your age and your overall health. Talk with your doctor if:

  • You have severe pelvic pain
  • Medication doesn’t get your symptoms under control
  • You have trouble getting pregnant
  • A growth in your pelvic area needs to be removed
Get the Best Treatment for Your EndometriosisAn expert outlines various endometriosis treatments and what questions can help you and your doctor find the best option for you.137

Kristin Patzkowsky, MD: There

are many different treatment

options for endometriosis.

It's important that the patient

talk to her physician

and discuss the options

and figure out what works best

for them.

So if someone comes

in with symptoms that might be

suggestive of endometriosis,

a trial of one

of the first-line therapies

might also be effective.

Some of the first-line therapies

for endometriosis

include birth control pills,

progesterone-only options

like IUDs,

implants, oral progesterone.

The medications that we

typically consider second line

medical therapies

are GnRH agonists and GnRH

antagonists, which put women

into a sort

of temporary menopausal state

or similar to that.

Also aromatose inhibitors, which

reduce total body estrogen.



If someone is still having pain

after trial of one

of the therapies, that might be

an appropriate time

for a diagnostic laparoscopy,

which is a surgery where we

place a small camera typically

through the belly button

to evaluate for any evidence

of endometriosis.



The surgery can include

excision, or cutting out

lesions, or ablating, or burning

lesions.

Most patients

after a surgical intervention,

medical therapy,

will respond very well

and have an improvement

in their symptoms,

though everyone is slightly

different in their course

and it's difficult to predict

how long someone's symptoms

might improve for.



So typically after a surgery,

we will resume some type

of hormonal therapy.

The problem with endometriosis

is that there's a high risk

of recurrence.

So even with surgery

or medical therapy, about 30%

of patients

will have recurrent pain.



It's important for patients

to be proactive in their care.

Patients should keep track

and see what worked

or what didn't work for them so

that we can figure out the best

treatment

plan for each patient's

individual course.

There is hope for patients who

have endometriosis.

There are a lot

of different treatment options

available,

both medical and surgical.

And there is research

into new medical therapies

that might also be effective.

Kristin Patzkowsky, MD, Assistant professor of gynecology Johns Hopkins Hospital/delivery/aws/8b/c4/8bc46e8d-0aa3-3f3c-bb49-a01a5b5f5c87/091e9c5e81dd23a0_funded-expert-treatments-for-endometriosis_,4500k,2500k,1000k,750k,400k,.mp412/11/2019 11:56:0018001200photo of doctor talking with patient/webmd/consumer_assets/site_images/article_thumbnails/video/get_the_best_treatment_endometriosis_video/1800x1200_get_the_best_treatment_endometriosis_video.jpg091e9c5e81dd23a0

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.

Continued

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.

What to Expect After Endometriosis Surgery

You might be tired for a few days after a laparoscopy. Your doctor may tell you not to drive for 2 weeks. They might also tell you not to have sex or do activities like swimming or bathing in a tub for about 2 weeks.

Recovery from a laparotomy is slower and can be more painful. It might take several weeks. During your recovery at home, you may not be able to do some everyday activities.

After a hysterectomy, your period will stop. If your doctor took out your ovaries as well as your uterus, you’ll go into menopause. You might have symptoms like hot flashes and loss of bone density. Talk to your doctor about how to manage them.

Endometriosis Surgery Risks

Complications of endometriosis surgery are rare. They include:

  • Damage to organs like your bladder or intestines
  • Damage to nerves or blood vessels
  • 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

Endometriosis Surgery Outlook

Most women have less endometriosis pain after laparoscopy. But the results may not last, and the pain can come back.

Research suggests that laparoscopy tends to work better for moderate endometriosis, rather than mild forms. If the affected areas, or “lesions,” are deep inside your body, you may be more likely to get relief if your doctor cuts the tissue out.

Laparotomy is just as effective as laparoscopy. Endometriosis returns in about 20% to 30% of women within 5 years of either type of surgery.

Up to 15% of women who have a total hysterectomy with their ovaries and fallopian tubes removed have more endometriosis pain later.

Symptoms of endometriosis usually go away during menopause.

WebMD Medical Reference

Sources

SOURCES:

Mayo Clinic: “Endometriosis -- Treatment.”

National Institutes of Health: “What are the treatments for endometriosis?”

UpToDate: “Patient education: Endometriosis (Beyond the Basics),” “Endometriosis: Surgical management of pelvic pain.”

Endometriosis.org: “Surgery,” “Laparoscopy: Before and after tips,” “Hysterectomy.”

Cleveland Clinic: “Surgical Treatment for Endometriosis.”

Mount Sinai Hospital: “Exploratory Laparotomy.”

American College of Obstetricians and Gynecologists: “FAQ: Endometriosis,” “FAQ: Laparoscopy.”

Victoria State Government Better Health Channel: “Laparotomy.”

NYU Langone Health: “Surgical Treatment for Endometriosis.”

Johns Hopkins Medicine: “Hysterectomy.”

University College London Hospitals: “Surgical treatment for endometriosis.”

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