Endometriosis Surgery

In addition to pain killers such as Ibuprofen and Paracetamol, as well as hormone treatments to reduce oestrogen levels in the body, surgery is also a treatment option for endometriosis sufferers - particularly those who are struggling to become pregnant. To understand how surgery can help rectify infertility caused by endometriosis and reduce unpleasant endometriosis symptoms, we first need to understand how the condition leads to fertility problems in the first place.

Endometriosis And Infertility

Approximately 40% of endometriosis sufferers struggle to conceive. The build up of endometrial tissue outside the womb can cause cysts, scarring and adhesions (when organs get stuck together), as well as blockages, inside the pelvis and abdomen. This can cause reproductive organs such as the fallopian tubes and ovaries to adhere to the lining of the pelvis or to one another. It may force reproductive organs into incorrect positions, which can prevent the successful transfer of a woman's eggs from her ovaries to her fallopian tubes, leaving no egg available for her partner's sperm to fertilise. The same effect can be created by clumps of endometriosis blocking the fallopian tubes. It's also possible that the build up of endometrial tissue causes the over-production of prostaglandins, hormones which may interfere with the processes of fertilisation and embryo implantation.

So How Does Surgery Help?

Surgery for endometriosis will initially aim to remove endometrial implants (clumps of endometrial tissue) from places where they shouldn't be (the fallopian tubes, the ovaries, etc.), as well as to drain any large cysts and separate any organs which have become stuck together. The hope is that this will free up the reproductive system and allow it to start functioning normally once again. The removal of the endometrial tissue should also reduce the painful symptoms of endometriosis and improve the sufferer's quality of life. In extreme cases, more radical surgery, such as the removal of parts of the reproductive system, may be recommended. This course of action is usually taken only if the patient is sure that she doesn't want to have any more children.

Types Of Surgery

The type of surgery performed will depend on the location of the endometrial tissue within the patient's body and the severity of her symptoms.

Laparoscopy - this surgical procedure (also known as keyhole surgery) is commonly used in the diagnosis and treatment of endometriosis because it is considered less invasive and taxing on the body than other types of surgery. It is often but not exclusively performed under general anaesthetic. Basically, one or more small incisions are made in the patient's lower abdomen, through which a laparoscope (like a miniature telescope) and surgical equipment are inserted into the affected area and used to remove endometrial tissue.

Laser surgery - laser surgery may be used as part of a laparoscopy procedure. Here, a laser is used instead of a scalpel to burn away cysts and cut away adhesions and implants. The advantages of the laser are that it is more precise and, when used correctly, causes less tissue damage than conventional surgical tools.

Hysterectomy - hysterectomy (the removal of the uterus and possibly other reproductive organs) is a major surgical procedure which seeks to eliminate the problems caused by endometriosis rather than alleviate them. This is an irreversible procedure which leaves the patient unable to have children. There are three types of hysterectomy:

Total hysterectomy - the removal of the uterus and cervix

Sub-total hysterectomy - removal of the uterus

Total hysterectomy plus bilateral salphingo-oophorectony - removal of the uterus, cervix, ovaries and fallopian tubes.

In Conclusion

Surgery has helped many women with endometriosis to achieve their dreams of becoming mothers. However, while it provides relief from symptoms and can return the reproductive system to normal function, it is not a cure. There is no cure for endometriosis - the condition can only be managed. Therefore symptoms may recur even after surgery. You should discuss surgical options and their side effects with your gynaecologist before making a well-informed decision regarding the best course of action for you.