Endometriosis Treatment

Laparoscopy is usually done under general anesthesia, although you can stay awake if you have local or spinal anesthetic. A gynecologist or surgeon performs the procedure.

For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide). The gas, which is injected with a needle, pushes the abdominal wall away from the organs so that the surgeon can see them clearly. The surgeon then inserts a laparoscope through a small incision and examines the internal organs. Additional incisions may be used to insert instruments to move internal organs and structures for better viewing. The procedure usually takes 30 to 45 minutes.

If endometriosis or scar tissue needs to be removed, your surgeon will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery).

After the procedure, the surgeon closes the abdominal incisions with a few stitches. Usually there is little or no scarring.

Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:

• Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
• Endometriosis pain that has continued or returned after hormone therapy.
• Severe endometriosis pain (some women and their doctors choose to skip medicine treatment).
• An endometriosis cyst on an ovary (endometrioma).
• Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.

Pain relief

As with hormone therapy, surgery relieves endometriosis pain for most women. But it does not guarantee long-lasting results. Some studies have shown:

• Most women—about 60 to 80 out of 100—report pain relief in the first months after surgery.

Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.

Infertility

If infertility is your primary concern, your doctor will probably use laparoscopy to look for and remove signs of endometriosis.

• Research has not firmly proved that removing mild endometriosis improves fertility.
• For moderate to severe endometriosis, surgery will improve your chances of pregnancy.
• In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.

After laparoscopy, your next steps depend on how severe your endometriosis is and your age. If you are older than 35, egg quality declines and miscarriage risk increases with each passing year. In that case, your doctor may recommend infertility treatment, such as fertility drugs, insemination, or in vitro fertilization. If you are younger, consider trying to conceive without infertility treatment.

Endometrioma

There are various ways of surgically treating an endometrioma, including draining it, cutting out part of it, or removing it completely (cystectomy). Any of these treatments brings pain relief for most women but not all. Cystectomy is most likely to relieve pain for a longer time, prevent an endometrioma from growing back, and prevent the need for another surgery.

Complications from the surgery are rare but include:

• Pelvic infection.
• Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
• Scar tissue (adhesion) formation after surgery.
• Damage to the bowel, bladder, or ureters (the small tubes that carry urine from the kidneys to the bladder).