Surgical Procedures for Endometriosis
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Surgical intervention is the most aggressive treatment for endometriosis. Surgery may be done if you:
- Do not respond to other treatment
- Are older and feel you need to become pregnant more quickly
- Have severe physical changes due to the disease
The two main surgical procedures used are laparoscopy and hysterectomy with or without bilateral salpingo-oophorectomy (removal of the tubes and ovaries).
]]>Laparoscopy]]> is a minor surgical procedure that is performed through small “keyhole” incisions in the abdomen. A very small camera and surgical instruments are inserted through these small openings. This camera projects a picture of the inside of the abdomen onto a video screen. It lets the surgeon see any endometrial tissue that may be on the uterus, fallopian tubes, ovaries, lining of the pelvis, and other structures. Surgical instruments are inserted through other small cuts and are used to cut away or burn off endometrial growths and to divide scar tissue.
For a laparoscopy, you will most likely be put to sleep with general anesthesia. This procedure usually takes about 1-2 hours, but may take longer depending on the amount of endometrial growths that need to be removed.
Laparoscopy is a good option if you wish to become pregnant or cannot take hormonal medications.
Generally considered the option of last resort, a ]]>hysterectomy]]> is the surgical removal of the uterus. The ovaries and fallopian tubes may be removed at the same time; this is called a bilateral salpingo-oophorectomy. During the procedure, endometrial growths on other organs are also removed.
This is generally considered the most effective treatment for severe endometriosis. Because the ovaries are playing a critical role in the hormonal stimulation of endometriosis and because they are usually involved in the actual disease implants, hysterectomy without removal of the ovaries often fails to be an effective treatment for the patient.
About 50% of women treated with hysterectomy alone later need another operation due to continued problems with endometriosis. After you have had this surgery, you cannot become pregnant and will have all of the side effects of menopause if your ovaries are removed.
For a hysterectomy, you will be put to sleep with general anesthesia. The procedure typically takes several hours, depending on the extent of the endometriosis.
American College of Obstetrics and Gynecology website. Available at: http://www.acog.org/ . Accessed March 2, 2006.
American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed March 2, 2006.
Kistner’s Gynecology and Women’s Health . 7th ed. Mosby-Year Book; 1999.
National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ . Accessed March 1, 2006.
The Society of American Gastrointestinal and Endoscopic Surgeons website. Available at: http://www.sages.org/ . Accessed March 2, 2006.
Farquhar C, Sutton C. The evidence for the management of endometriosis. Curr Opinion in Obstet & Gynecol. 1998;10(4):321-332.
Jacobson TZ, Barlow DH, Garry R, Koninckx P. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database of Systematic Reviews. 2001;(4):CD001300.
Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
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