Laparoscopic Surgery for Endometriosis
http://www.webmd.com/infertility-and-reproduction/guide/laparoscopic-surgery-for-endometriosis
Laparoscopy is the most
common procedure used to diagnose and remove mild to moderate endometriosis.
Instead of using a large abdominal incision, the surgeon inserts a lighted
viewing instrument called a laparoscope through a small incision. If the
surgeon needs better access, he or she makes one or two more small incisions
for inserting other surgical instruments.
If your doctor recommends a laparoscopy,
it will be to:
Laparoscopy
procedure
You will be advised not to eat or
drink for at least 8 hours before a laparoscopy. Laparoscopy is usually done
under general anesthesia,
although you can stay awake if you have local or spinal anesthetic. A
gynecologist or
surgeon performs the procedure.
For a laparoscopy, the abdomen
is inflated with gas (carbon dioxide or nitrous oxide). The gas, which is
injected with a needle, pushes the abdominal wall away from the organs so that
the surgeon can see them clearly. The surgeon then inserts a laparoscope
through a small incision and examines the internal organs. Additional incisions
may be used to insert instruments to move internal organs and structures for
better viewing. The procedure usually takes 30 to 45 minutes.
If endometriosis or scar tissue
needs to be removed, your surgeon will use one of various techniques, including
cutting and removing tissue (excision) or destroying it with a laser beam or
electric current (electrocautery).
After the procedure, the surgeon
closes the abdominal incisions with a few stitches.
Usually there is little or no scarring.
What
To Expect After Surgery
Laparoscopy is usually done at an
outpatient facility. Sometimes a surgery requires a hospital stay of 1 day. You
will likely be able to return to your normal activities in 1 week, maybe
longer.
Why
It Is Done
Laparoscopy is used to examine the
pelvic organs and to remove implants and scar tissue. This procedure is
typically used for checking and treating:
When
laparoscopy may not be needed
Directly viewing the pelvic organs
is the only way to confirm whether you have endometriosis. But this is not
always needed. For suspected endometriosis, hormone therapy is often
prescribed.
How
Well It Works
Pain
relief
As with hormone therapy, surgery
relieves endometriosis pain for most women. But it does not guarantee
long-lasting results. Some studies have shown:
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.1
Infertility
If infertility is your primary
concern, your doctor will probably use laparoscopy to look for and remove signs
of endometriosis.
After laparoscopy, your next steps
depend on how severe your endometriosis is and your age. If
you are older than 35, egg
quality declines and miscarriage
risk increases with each passing year. In that case, your doctor may
recommend infertility
treatment, such as fertility
drugs, insemination,
or in
vitro fertilization. If you are younger, consider trying to conceive
without infertility treatment.
Endometrioma
There are various ways of surgically
treating an endometrioma, including 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.3
Risks
Complications from the surgery are
rare but include:
What
To Think About
The benefits of laparoscopic surgery
compared with open abdominal surgery include less tissue trauma and scarring
and smaller incisions along with being able to have an outpatient procedure or
a shorter hospital stay and a shorter recovery time.
The skill of the surgeon is critical
when surgery is used to treat endometriosis that is causing infertility. The
use of a laparoscope, lasers, and some of the operative procedures require
additional training for a surgeon. Doctors report varying pregnancy rates after
endometriosis surgery.
In vitro fertilization (IVF), an assisted
reproductive technology, is an alternative to surgery to correct
infertility caused by endometriosis.
Complete the surgery
information form (PDF) to help you prepare for this surgery.
Citations
1.
Ferrrero S, et al. (2010). Endometriosis, search date December 2009.
Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
2.
Fritz MA, Speroff
L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility,
8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
3.
American College of Obstetricians
and Gynecologists (2010). Management of Endometriosis. ACOG Practice Bulletin
No. 114. Obstetrics and Gynecology, 116(1): 225–236.
4.
American Society for Reproductive
Medicine (2012). Endometriosis and infertility: A committee opinion. Fertility
and Sterility, 98(3): 591–598.
Endometriosis
Patient Education Center
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WebMD's Women's Health Health Center • Newly
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