Laparoscopic surgery for endometriosis: types and recovery


Although endometriosis cannot be cured, the pain and infertility caused by endometriosis can be improved with laparoscopic surgery, considered the gold standard of treatment. Laparoscopy is usually a well-tolerated and effective surgery to remove endometriotic patches.

This article discusses the types of endometriosis surgery, recovery, success rates, and financial considerations.

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When to have surgery for endometriosis

Endometriosis affects up to 11% of women of reproductive age. Treatment may include lifestyle changes, oral medications, physical therapy, and surgery. Non-surgical medical management is performed proactively to slow the progression of endometriosis and reduce symptoms. Surgical intervention may be required in the following situations:

  • undiagnosed pelvic pain: Your health care provider may diagnose you with endometriosis based solely on your symptoms. Laparoscopy may be required for confirmation.
  • To improve fertility outcomes: Endometriosis surgery combined with assisted reproductive technology (ART) may improve chances of conception.
  • Pain that persists after surgery: Recurrence of pelvic pain within 2 years after surgery can occur in 8 out of 10 women and warrants further surgical workup.

Other symptoms of endometriosis that do not improve with drug therapy, such as heavy bleeding, chronic constipation, difficulty urinating, and scar tissue formation, may also require surgical removal of endometrioid lesions.

Is endometriosis surgery a major operation?

How well you tolerate surgery for endometriosis depends on the type of surgery, the severity of your symptoms, and your current health. Most endometriosis surgeries are minimally invasive (laparoscopic).

If endometriosis is extensive, the health care provider may decide to perform a laparotomy, which involves making a large incision in the abdomen. However, open surgery is rarely performed for endometriosis today. People with comorbidities (intercurrent health conditions) such as high blood pressure, diabetes, and obesity may need more complex surgery and may take longer to recover.

Types of Endometriosis Surgery

Surgery for endometriosis is classified into conservative surgery and radical surgery. Conservative surgical techniques remove the endometriotic patch to preserve organs and fertility, while radical surgical intervention removes the endometriotic affected organs. Types of surgery for endometriosis include:

  • Laparoscopy: Laparoscopy helps diagnose and remove endometrioid lesions. Ablation can also be done.
  • laparotomy: A laparotomy is a large abdominal surgery that helps visually identify and remove extensive endometriotic patches that may have invaded other organs.
  • hysterectomy and Ovariectomy: A hysterectomy is an operation to remove the uterus and an oophorectomy is an operation to remove the ovaries.

Surgical techniques to remove endometriosis

In laparoscopic resection or ablation, the surgeon makes several small incisions in the abdomen instead of making one large incision. Laparoscopy is usually a well-tolerated procedure with a short hospital stay and minimal risk of infection.

Laparoscopic resection

In a laparoscopic resection, a surgeon removes (removes) the endometriosis patch using laparoscopic instruments. Endometrial-like tissue is removed through one of the incisions.

Laparoscopic ablation

In laparoscopic ablation, the surgeon uses laser or energy-generated heat to burn and destroy the lesion. Care should be taken not to damage healthy tissue or organs around the endometriosis patch.

How successful is endometriosis surgery?

Surgery for endometriosis is successful for most people. Patients with moderate to severe pain may report better postoperative outcomes than those with mild pain. However, symptoms of endometriosis may return. Recurrences often occur 2 to 5 years after surgery.

What to Expect Before Endometriosis Surgery

Your surgeon’s office will give you written instructions to help you prepare for surgery for endometriosis. A nurse may call you a few days in advance to confirm these instructions.

days to surgery

In the days leading up to surgery, be sure to:

  • stop taking blood-thinning drugs: Anticoagulants may increase bleeding during surgery.
  • quit smoking: Smoking can delay healing and cause infections.
  • stop eating and drinking: It is essential to be hungry on the day of surgery, and you may be asked not to eat or drink for 6-12 hours before surgery.
  • prepare the intestine: Your surgeon may prescribe oral laxatives and enemas the day before or the morning of your surgery. An empty bowel helps the surgeon better visualize the abdominal and pelvic organs and reduces the risk of infection. However, there is no clear evidence to support this practice. Bowel preparation may not be necessary for some surgeons.
  • receive a prescription: These include pain relievers and antibiotics that may be prescribed for use after surgery.
  • arrange a driver: You will not be able to drive after surgery, so please arrange a driver in advance.

morning of surgery

Before going to the hospital, remember:

  • Remove all decorations.
  • Do not eat or drink.
  • Please wear comfortable, loose-fitting clothing.
  • Follow the instructions as to whether or not to take your regular medication.

in a hospital or clinic

Check in at the front desk, provide your insurance information, and complete a health history form. A nurse will escort you to the preoperative room, where you will change into a hospital gown. A nurse will check your vital signs, assess your health, and place an IV (intravenous line). Intravenous drips give drugs before, during, and after surgery. You will also have the opportunity to use the restroom.

After checking the chart, the anesthesiologist will visit you in the hospital room. Review your health history and explain the type of anesthesia to be used. Your anesthesiologist will explain what to expect during surgery. The surgeon will also meet with you to explain the surgery, answer your questions, and get your consent to perform the surgery.

In the operating room, an anesthesiologist administers a drowsy drug through an IV and provides additional oxygen through a face mask. Once you are asleep, an anesthesiologist will insert a breathing tube through your mouth into your windpipe and give you special gases and drugs to help you stay asleep during the procedure. You will be closely monitored and cared for during surgery.

What Happens During Endometriosis Surgery?

A so-called time-out with the medical team takes place before the start of surgery to ensure that the correct procedure is given to the right person. The abdomen is cleaned and prepped before surgery begins.

The surgeon makes a small incision near the navel or pelvis. A small, hollow instrument called a trocar is then placed through the incision. A tube through the trocar pumps carbon dioxide gas into the abdominal cavity. In some cases, gas may be injected into the abdomen through a Veress needle. A trocar is placed after the abdomen is inflated with gas.

Once the abdomen is properly inflated, the surgeon can remove the gas tube and use a laparoscope (a camera that projects a video image onto a monitor in the operating room) to better visualize the abdomen. Additional abdominal incisions are made so that more instruments can be used during surgery. The number of incisions required depends on the type of endometriosis surgery and the severity of the symptoms.

When removing or excising an endometriosis patch, the abdominal cavity is vented, the trocar is removed, and the incision is sutured or glued closed.

What happens after surgery for endometriosis?

After surgery, you will be transferred to the post-operative room. A nurse will closely monitor you until you wake up from anesthesia. Common postoperative side effects include:

  • groggy or sleepy
  • dry mouth and throat
  • have nausea or vomiting
  • experiencing stomachache
  • Pain in the shoulders and chest due to excess gas remaining in the abdomen

Postoperative nurses can relieve these symptoms with drugs, hot and cold compresses, repositioning, and ice chips to suck on. If you are going home the same day, you should demonstrate that you are able to urinate and that your pain is well controlled before you leave the hospital.

Endometriosis recovery: how long does it take?

Recovery from endometriosis surgery depends on the type and complexity of the surgery and your health.

You may feel tired during the first week after surgery. Shoulder pain from excess gas should subside within about 48 hours. Abdominal incision discomfort begins to decrease within the first few weeks. Lifting may be limited as directed by the surgeon. Most people feel well enough to return to work 10 to 14 days after surgery.

A full recovery is different for each person. If you have extensive endometriosis and require long-term surgery and removal of deep endometriotic patches, it may take months to fully recover.

First period after endometriosis surgery

Menstruation (menstrual flow) may resume 4 to 6 weeks after surgery. If the endometriosis patch is removed from the ovaries and fallopian tubes, the first period can be painful due to inflammation and tenderness of these organs.

You may also notice that the flow is heavier than usual and the spasm increases. It may take several months for your period to return to normal. Avoid foods that cause bloating, drink plenty of water, exercise lightly, and try over-the-counter pain relievers to reduce discomfort.

Can endometriosis come back after surgery

Surgery for endometriosis may improve symptoms, but one study found that over a decade, 51% of women required another surgical intervention to treat recurrences of endometriosis. was shown. Even after radical surgery, such as a hysterectomy or oophorectomy, there is a small chance that endometriosis will recur. Risk factors for follow-up procedures include:

  • Be under 30 years of age at the time of first surgery
  • ovarian endometriosis
  • Endometriosis patch not completely removed
  • Adhesions to the Douglas sac (the small area between the uterus and rectum), intestine, fallopian tubes, or ovaries
  • Advanced stages of endometriosis
  • Certain Subtypes of Endometriosis

One study found that postoperative hormonal suppression may reduce the recurrence of endometriosis.

Fertility and family planning after endometriosis surgery

Although the link between endometriosis and infertility is not fully understood, studies have shown that surgery can double the rate of spontaneous pregnancy in patients with mild endometriosis. I’m here.

Patients with moderate to severe endometriosis also have improved spontaneous birth rates after laparoscopic removal of endometrioid lesions. ART has proven to be the most effective option for pregnancy after endometriosis surgery.

Cost and insurance coverage

The cost of endometriosis surgery depends on insurance coverage. There are additional costs for medical services offered by providers or organizations not included in the network. The average cost of uninsured endometriosis surgery is over $8,000.

Health Tips After Endometriosis Surgery

Good health after surgery for endometriosis is important for physical and mental health. Try these tips to stay healthy and happy after endometriosis surgery.

  • Drink lots of water.
  • regular exercise.
  • If you get tired, rest and take a nap.
  • Eat a diet rich in omega-3s, vitamin E, vitamin C and citrus fruits.
  • Maintain a healthy weight.
  • Take hormone-suppressing medications if they are prescribed.
  • do not smoke;
  • Reduce or eliminate alcohol.
  • Report signs of infection such as fever, chills, redness or bleeding at the incision site.

summary

Surgery is necessary to improve the quality of life for many endometriosis patients. Laparoscopic surgery is the most standard technique for removing endometriotic patches. This procedure is usually done as a well-tolerated outpatient procedure.

Recovery time depends on the type and complexity of the surgery. Most insurance companies will cover the cost of endometriosis surgery, but there are ways to pay for the surgery without insurance coverage. A healthy lifestyle can improve quality of life after surgery for endometriosis.



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