Surgical treatment for Endometriosis

Surgical treatment for endometriosis is used in various situations. It is used for both diagnosis as well as for treatment where the disease is surgically removed.

Surgical options for endometriosis are usually carried out in one of the following situations:

At the time of diagnosis for mild to moderate disease
If medical treatment has not worked
If sub-fertility is a problem
If there is moderate to severe disease
When endometriosis recurs

Surgery for endometriosis can be classed as either conservative, complex or radical

The aim of conservative surgery is to return the appearance and function of the pelvic organs to as normal as possible. This means destroying any endometriotic deposits, removing ovarian cysts, dividing adhesions and removing as little healthy tissue as possible.

Radical surgery means performing a hysterectomy with removal of both ovaries and is reserved for women with very severe symptoms, who have not responded to medical treatment or conservative operations.

There are new developments in surgery that can reduce further adhesions - read HERE for more details

Treatment at the time of diagnosis

This approach is becoming standard practice in the management of endometriosis. It is usually carried out where the level of the disease is classed as mild to moderate. Removal of diseased tissue will take place during the first surgical procedure, rather than just doing a diagnosis.

Laparoscopy surgery

Laparoscopy surgery is the surgical procedure used for diagnosis as well as for treatment of mild to moderate cases. This is known as conservative surgery, where attempts are made to restore the pelvic anatomy to as close to normal as possible.

A laparoscopy enables a physician to look directly inside the abdomen and observe the anatomy and health of the pelvic cavity.

To perform a laparoscopy a small incision is made, usually about ¼ inch, right underneath the naval. A very small telescope-like instrument is then inserted. This instrument is attached to a light source which illuminates the pelvic cavity. The physician can then look directly inside the cavity. During this procedure any Endometrial growths can be removed.

For a full explanation of the laparoscopy procedure read HERE

Surgical Management of Endometriosis

Mild to moderate disease - Conservative Surgery

Conservative surgery refers to an operation where your surgeon performs a laparoscopy (keyhole surgery) to remove as much of the disease as possible like cysts and any other signs of endometriosis you might have. This is done to help ensure preserving your reproductive organs.

Moderate to severe disease - Complex Surgery

Depending on the severity of your endometriosis, you may need to undergo more complex surgery that involves different organs within the body, such as the bowel or the bladder. This type of operation is usually carried out under the care of a multi-disciplinary team, such as a gynaecologist working together with a urologist, colorectal, or thoracic surgeon where required.

Radical Surgery - Hysterectomy

More radical surgery can be considered if a patient has not responded to drug treatments or conservative surgery and is not planning to start a family. Radical surgery refers to a hysterectomy or oophorectomy.

Hysterectomy is the removal of the womb, and is performed under general anaesthetic. It can be done with or without removing the ovaries. If the ovaries are left in place, then the chance of endometriosis returning is increased as the ovaries are still producing estrogen which can feed the endometriosis. Some women may need a further operation to remove the ovaries at a later date.

Oophorectomy is the removal of the ovaries. When both ovaries are removed, the surgical procedure is called ‘bilateral oophorectomy,’ whereas the removal of only one ovary is called ‘unilateral oophorectomy.’ When both ovaries are removed, a patient will experience an instant and irreversible menopause. Hormone replacement therapy (HRT) is often offered after an oophorectomy (removal of the ovaries) for endometriosis, particularly for younger women to protect against bone loss and heart risks.

Due to severe endometriosis, many women are driven to the measure of having a hysterectomy in the hope that it will rid them of Endometriosis. Unfortunately this action does not always solve the problem. Please read the Hysterectomy page HERE and see the testimonials from other women who have found that endometriosis has returned even after having a hysterectomy.

Combined treatment

This form of treatment involves combining surgery and drug therapy. An example is when Danazol is taken for 6 weeks prior to an operation to shrink the endometrial growths, with the aim to make surgical removal much easier.

Following surgical removal of endometrial tissue, birth control pills may be prescribed that contain both oestrogen and progesterone, to be taken continuously for up to nine months. This will induce a pseudo-pregnancy, with the aim to allow the body time to rest and heal.

Recurrence of endometriosis after surgery

Recurrence rate for endometriosis has been estimated to be 10% per year. One study found it to recur in 40% of women within 5 years after conservative surgery. There is a 6 times higher risk of recurrence after hysterectomy if the ovaries are not removed. Even in women who have their ovaries removed, there is still a risk of further recurrence of Endometriosis.

Surgical treatment for Endometriosis

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