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
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
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
include birth control pills,
implants, oral progesterone.
The medications that we
typically consider second line
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
The surgery can include
excision, or cutting out
lesions, or ablating, or burning
after a surgical intervention,
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
So even with surgery
or medical therapy, about 30%
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
plan for each patient's
There is hope for patients who
There are a lot
of different treatment options
both medical and surgical.
And there is research
into new medical therapies
that might also be effective.
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.
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:
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.