At some point in your treatment for endometriosis, your doctor will likely recommend surgery. What type of surgery, how the surgery is performed and, most importantly, the reason for the surgery should all be part of your decision as to whether or not to undergo any operation.
Typically, experts agree that an integrative approach—one that uses both medical and surgical treatments—works best for managing endometriosis. As to which is better, well, no one knows. There have been no head-to-head clinical trials comparing the two.
The most commonly used surgeries for endometriosis are:
Laparoscopy. This is a minimally invasive procedure to remove the "lesions" of endometriosis. During a laparoscopy, the surgeon views your abdominal area and reproductive organs through a tiny lighted telescope inserted through one or more small incisions in your abdomen. From there, the surgeon can either cut out the endometrial tissue or destroy it with heat or laser.
Laparotomy. This is a more involved surgery requiring an abdominal incision. The major negative of this type of surgery is that it typically requires a much longer recovery time involving more pain and disability.
Studies are mixed as to which type of surgery is best. Some show lower rates of recurrence and higher rates of pregnancy with laparotomy; others show just the opposite. Both types of surgery carry a risk of scar tissue and adhesions, which could lead to infertility, make pain worse, require additional surgeries or damage other pelvic structures. Adhesions form as a result of injury or trauma to the peritoneum, the clear membrane that covers the inside of the abdomen and all abdominal and pelvic organs, except the ovaries. When healthy, this membrane is slippery. Once injured, however, the immune system kicks in to repair things, leading to inflammation and the production of sticky scar tissue called a fibrin matrix.
Normally, these bands of scar tissue dissolve through a biochemical process called fibrinolysis, the process that enables a cut on your finger and any resulting scab to heal.