Treating endometriosis and its symptoms is a very personal choice.
There are various treatment options including surgeries, lifestyle changes, and medications, all of which come with special considerations around values, financials, and your future goals.
In this blog post, we look at the various surgical options available. We will cover:
Why is endometriosis surgery done?
When is it time for endometriosis surgery?
Laparoscopy surgery for endometriosis
Laparotomy surgery for endometriosis
Hysterectomy for endometriosis
What to expect after endometriosis surgery
Endometriosis surgery risks
Endometriosis surgery outlook
NOTE: At ELANZA, we believe that when it comes to endometriosis, there is not a best or only choice about which treatment options to pursue, there is just the solution that works for you. There are important considerations around every treatment plan and our single mission is to provide evidence and options so that anyone with endo has the ability to advocate for themselves and to make informed decisions about their care. We have no vested interest in any single treatment plan (i.e. surgery, medication, etc.). Our mission is to improve access to specialist care, whatever that entails.
Why is endometriosis surgery done?
Endometriosis is a condition in which the type of tissue that lines the 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 has not helped ease your symptoms substantially and your quality of life is suffering.
An endometriosis specialist can find the endometriosis inside your body and remove 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 or a care navigator 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
Laparoscopy surgery for endometriosis
In some cases, your doctor may refer you to a surgeon for a procedure that allows the surgeon to view inside your abdomen (laparoscopy).
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 lets your doctor see inside your body.
While you're under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.
A laparoscopy can provide information about the location, extent and size of the endometrial implants. Your surgeon may take a tissue sample (biopsy) for further testing.
Often, with proper surgical planning, your surgeon can fully treat endometriosis during the laparoscopy so that you need only one surgery.
Before a laparoscopy, you’ll get general anesthesia medication to put you to sleep.
Your doctor will make a small cut in your belly button 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 2 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.
What are the risks of a laparotomy?
infections in the bladder, uterus, or surrounding tissues
uncontrolled bleeding
bowel, bladder, or ureter damage
scarring
Laparotomy surgery for endometriosis
A laparotomy is a 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.
Using a laparotomy for endometriosis is rare.
However, it’s possible that it may be used when endometriosis is extensive or your doctor needs to remove patches of endometriosis that can’t be seen well using laparoscopy.
What are the risks of a laparotomy?
Infection in the bladder, uterus or cuts on the abdomen
Bleeding
Organ damage to bladder, bowel, ureter, uterus, fallopian tube, ovary, blood vessels, and nerves. Additional surgical procedures may be needed to fix any damage
Organ damage may not be identified at the time of surgery (delayed diagnosis), and require a second surgery to repair the damage when it becomes known Blood clots in the legs or lungs
Failure to treat all endometriosis, or failure to improve symptoms
Scar tissue formation
Hysterectomy for endometriosis
Your doctor may need to remove some or all of your reproductive organs if they’re damaged or have endometriosis tissue on them.
The removal of your uterus is called a hysterectomy.
There are three types:
Partial hysterectomy: In this procedure, also known as a supracervical hysterectomy, the uterus is removed but not the cervix.
Total hysterectomy: The entire uterus, including the cervix, is removed.
Hysterectomy and salpingo-oophorectomy: The uterus and one or both ovaries and fallopian tubes are removed.
If you're considering a hysterectomy, it's important to understand the probable outcomes and the alternatives that may be more appropriate for your specific condition.
Having a hysterectomy is a big decision with serious ramifications to consider.
It's irreversible.
You'll be permanently sterile (unable to get pregnant).
Removing the ovaries triggers menopause and often requires hormone replacement therapy.
After news spread of Lena Dunham’s total hysterectomy to treat her endometriosis, a global conversation began to unfold: Is a hysterectomy an effective form of endometriosis treatment?
“There is no certainty that a hysterectomy will rid a patient of their endometriosis,” Harry Reich, informally known as “the father of endometriosis,” tells The Blossom.
Reich is also credited with performing the nation’s first laparoscopic hysterectomy for endometriosis in 1988.
“It is in the case of diffuse adenomyosis, or endometriosis throughout the wall of the uterus itself when a patient starts to consider a hysterectomy as an option to relieve the pain associated with this form of the disease.”
Reich, who served as the previous director of advanced laparoscopic surgery at Columbia Presbyterian Medical Center, also emphasizes that it is imperative doctors remove endometriosis in areas outside of the uterus at the time of performing the hysterectomy.
Dr. Karli Goldstein, an OB-GYN who specializes in the surgical treatment of endometriosis, agrees.
“Oftentimes, doctors may fail to recognize the disease that lies outside the scope of the hysterectomy procedure, or outside of the uterus,” Goldstein tells The Blossom.
“It is essential, even in the case of a hysterectomy, that excision of endometriosis is always performed at the same time in order to treat the rest of the disease within the pelvis. If a surgeon performs a hysterectomy, but still leaves lesions behind elsewhere, patients are at risk of having persistent symptoms.”
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 those whose symptoms don’t go away despite other treatments and who don’t plan to have children down the road.
Is a hysterectomy a cure for endometriosis?
A hysterectomy relieves the symptoms of endometriosis for many people, but the condition can recur after the surgery, and the symptoms can persist.
Having surgery doesn’t always cure endometriosis. All the excess endometrial tissue needs to be removed, along with the uterus. If any tissue is left behind, it could continue to grow.
Some of the possible complications are:
general anesthetic complications
bleeding
ureter damage
bladder or bowel damage
infection
blood clots
vaginal problems
ovary failure
early menopause
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.
Endometriosis surgery outlook
Most individuals have less endometriosis pain after a laparoscopy. But the results may not last, and the pain can come back, 39.5% of individuals reported that lesions returned after laparoscopic removal
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 9% to 28% of women within 5 years of either type of surgery.
The key takeaway
Surgery is a big and personal choice, it can be scary and confusing. If you are considering any form of endometriosis surgery and are looking for a specialist care navigator to talk through your options, sign up today to access a holistic care platform to help manage your endometriosis and improve your quality of life.
