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Surgical treatment

Last updated on 29th March 2016

Laparoscopy and treatment

This is a technique in which a thin telescope is inserted into the abdomen to inspect the pelvic organs. A 1cm incision is made within or under the umbilicus and the abdomen is filled with gas. This distension allows the surgeon to inspect the pelvic organs to confirm the diagnosis of endometriosis. Another small incision is made close to the pubic hairline.

If any endometriosis is seen then usually up to a futher three incisions may be made to allow treatment to the affected areas. The surgeon would then either cauterise (burn) or remove the affected areas. Occassionaly there are further incisions required during the surgery.

You may be required to have drugs prior to surgery or if the tissue is very vascular your surgery may entail partial treatment and then drugs and a second planned procedure. In other words, your surgery may be undertaken in two stages to optimise complete removal of disease.

Bowel preparation

You will be given medicine the day before surgery to clean out your bowels. This will help with the surgery and may reduce the risk of complications if the bowel is involved. As your bowels have been cleared out before the operation, you may not necessarily open your bowels prior to being discharged home following surgery.

Minor surgery

Minor surgery will involve inspection and cauterising or removing the endometriosis tissue or spots.

Adhesions (scar tissue) would be divided.

An endometrioma or chocolate cyst (cyst filled with endometriotic fluid) will be opened and drained. The cyst will then be treated. Care will be taken to preserve as much normal ovarian tissue as possible and reconstruct the ovary where required.

You will have a catheter (tube in the bladder) overnight.

You may also have a PCA (patient controlled analgesia) overnight where you have the control pain relief medication which you may administer yourself by pressing a button.

Usually you would be discharged the following day. The duration of stay depends on the extent of endometriosis.

Major surgery

Extensive surgery is achieved through the telescope, though a slightly longer duration of stay may be needed. Occasionally an open incision is required to complete the surgery.

This would involve:

  1. Cutting away the endometriosis affected tissue
  2. Releasing ovaries
  3. Releasing adhesions and removing the tissue affected by endometriosis around the back and the side of the uterus, around the bladder and ureter and the space between the rectum and the vagina
  4. Dissecting the ureters (tubes that carry urine from the kidneys to the bladder) to be able to remove endometriosis tissue

Bladder disease

If severe endometriosis affects the bladder (Anterior disease) or is found close to the bladder then:

Bowel disease

The bowel may sometimes be involved with endometriosis. The surgical treatment involves dissecting the bowel free and assessing the degree of involvement. At times nothing more needs to be done, however, at other times the endometriosis may need to be cut away.

The surgical approach is determined by the degree of bowel involvement. This may require taking off the surface layer of the bowel or taking out a small disc of bowel and sewing up the resulting hole. Sometimes, if the involvement is extensive a small section of the bowel needs to be removed and the bowel rejoined.

These procedures are done together with the laparoscopic bowel surgeons depending on the extent of bowel surgery required.

The surgery may require an additional 3 cm cut in the pubic hair line.

Occasionally if the bowel join is very low (near the anus) or the operation has been technically difficult then a stoma bag is required (ileostomy). This effectively diverts the faeces into a bag on the abdomen thus protecting the join down stream and allowing it to heal. The stoma bag is usually left for three months and then requires a smaller operation to return the bowel into the abdomen. This usually requires a hospital stay of two to three days.

Surgical risks

The risk of a major complication from a laparoscopy only is about 1 -2 per 1000. The risk from the most major type of laparoscopic surgery for endometriosis is up to 1 in 10. The members of the surgical team will discuss all the risks listed below in detail when you will sign the consent form for the operation.

As with all surgery the associated risks may include:

If any of these complications occur, a laparotomy (open surgery through a larger cut) may need to be undertaken to correct the damage or to stop bleeding.

If you experience sudden or increasing pain at home, or are vomiting or feel unwell please seek medical advice immediately.

If you are unable to pass urine please attend A&E urgently as you maybe in urinary retention

Where surgery is carried out for pain it is important to appreciate that although we expect the operation to result in improvement, in some situations pain will remain and further investigations and treatment may be required. This can be the case even in patients having a hysterectomy for pain.

Images

R/V endometriosis diagram Endometrioma Minor endometriosis Utero-sacral nodule Bladder nodule Bowel endometriosis

Videos

Bladder nodule Bowel endometriosis Endometrioma Mild endometriosis
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