If you have endometriosis, a condition in which uterine tissue grows outside the uterus in your abdomen or pelvic area, it can cause pain and excessive bleeding during your period. It can also make it harder to conceive. If your doctor suspects you have endometriosis, he or she will probably start you on hormone therapy as a first-line treatment. But, if you still have pain, are trying to get pregnant, or cannot take hormones, your doctor may suggest surgery.
Doctors typically use minimally invasive techniques to treat endometriosis surgically. The incisions are very small, which makes recovery easier. Some people need more extensive endometriosis surgery, such as hysterectomy, so it’s important to be informed about the risks and benefits of different procedures.
The only way to confirm a diagnosis of endometriosis is with a procedure called a laparoscopy, sometimes followed by a tissue analysis. Some surgeons do imaging tests before surgery, such as an ultrasound or MRI, to get a better idea of the location of endometrial implants. Most gynecologists can perform laparoscopies and remove limited endometriosis. But special skill is required when the implants are widespread or in places that are hard to get to. Make sure you understand your surgeon’s surgical experience and areas of expertise before consenting to endometriosis surgery.
Before your surgery, you’ll be given instructions about how to prepare. If you are on certain medications, including metformin or certain hormones, your doctor will ask you to stop taking them a few days before your operation. If there is a possibility of endometriosis in or near your bowel, you need to do a bowel prep. There will be other general instructions about food, clothing, and transportation.
During the operation, you’ll be under general anesthesia. The doctor will make one or more incisions in your abdomen to insert the laparoscope, a narrow tube with a camera at the end. The surgical team pumps carbon dioxide into the area, which makes it easier to examine the organs with the laparoscope. If the surgeon sees endometrial implants, they may remove them during your laparoscopy using either or both of these techniques:
Destruction—uses a laser or heat device to burn off the implants. Carefully removing all of the implant helps reduce the chance of it growing back.
Excision—surgically removes the implants if the lesions go deep into other tissue, such as the bowel.
If you have implants that are challenging to remove because of their location or spread, your surgeon may decide to remove them in a separate operation.
You can usually go home the same day of your laparoscopy, but your activity will be restricted for a time. The restrictions and postoperative instructions can vary, but are likely to include some of the following:
Take it easy for 24 hours (or more if necessary)
Wait two days, or as instructed, before bathing or showering
Eat lightly for a day after your surgery
Stay hydrated to avoid constipation
Do not drive until your doctor clears it
Refrain from intercourse until your doctor clears it
Avoid swimming and hot tubs
There may be additional postop instructions. Following them closely will help prevent complications.
You may feel tired and somewhat sore in your abdomen for several days. The exact length of time depends on how extensive your operation is and how much tissue your surgeon removed. You may also have some shoulder pain from the gas that expands your abdomen during surgery.
You’ll need to see your doctor for a follow up visit anywhere from 2 to 6 weeks after your laparoscopy to make sure you are healing well and discuss a long-term treatment plan, as endometriosis can recur after surgery. You will probably have hormone therapy to reduce the chance of the implants coming back. If endometriosis does return, you can have additional laparoscopies to remove it.
Rarely, if your endometriosis is causing severe symptoms and other treatments have not worked, your doctor may talk with you about a hysterectomy. This is an operation to remove the uterus. There is debate about this procedure because, as the endometrial tissue lies outside the uterus, removing the uterus may not address the problem. The decision to have a hysterectomy or remove other reproductive organs is a serious one, because it means you will not be able to have children afterwards. If you are premenopausal and your operation includes ovary removal, you will enter menopause.
There are different surgical approaches for hysterectomy. Make sure you understand the risks and benefits of such surgeries before making your final decision.
For most women, hormone therapy or laparoscopy will reduce pain and bleeding. Many women find relief from the symptoms of endometriosis without surgery, but where it is necessary, it can be effective and give you years of pain relief. With today’s techniques like 3D imaging and robotic-assisted gynecologic surgery, your surgeon can find and remove endometrial tissue with great precision
