Laparoscopy and endometriosis

A laparoscopy (keyhole surgery) can be used in the diagnosis or treatment of a number of conditions of the abdomen and pelvis. The advantage of laparoscopy is that only small cuts (incisions) are required. 

The added advantage of laparoscopy in endometriosis is that your diagnosis can be confirmed and treatment can be carried out at the same time. It can also rule out some other conditions that may be contributing to your symptoms.

If endometriosis can be seen during the laparoscopy, a sample will usually be removed for examination under the microscope. This will confirm the diagnosis.

Your treatment will depend on where the endometriosis is found and how much is found.

Spots of endometriosis throughout the pelvis can be removed surgically (excision) or be treated by destroying the cells using diathermy (ablation). Endometriosis cysts in the ovaries (endometriomas) will usually be removed, although ablation is sometimes performed.

Studies have shown that five years after surgery, up to 70 per cent of women will have no evidence of endometriosis returning.

Not all endometriosis can be treated with laparoscopy, however. Sometimes endometriosis affects other organs such as the bowel or ureter (the tube from the kidney to the bladder). If this is the case, you may require further surgery at a later date. Further surgery is likely to involve other specialist surgeons.

Excision or Ablation?

Surgical treatment may use either excision (removal of the endometrial tissue using cutting), ablation (which involves destroying the endometriosis cells using diathermy) or a combination of both techniques. The choice of technique is made by the surgeon depending on the size and location of the lesion to be treated. If either technique is appropriate, excision is generally performed to allow the tissue to be sent for examination under the microscope to confirm the diagnosis.

Risks

There are risks with all surgery. With laparoscopy for endometriosis, problems are rare but can be severe. They include:

• Infection in the bladder, uterus or cuts on the abdomen
• Bleeding – (one in five hundred)
• Organ damage to bladder, bowel, ureter, uterus, fallopian tube, ovary, blood vessels, nerves – (one in five hundred). Additional surgical procedures may be needed to fix any damage
• Organ damage may not be identified at the time of surgery (delayed diagnosis), and require a second surgery to repair the damage when it becomes known (one in three thousand)
• Blood clots in the legs or lungs (less than one in one hundred)
• Failure to treat all endometriosis, or failure to improve symptoms
• Scar tissue formation
• Death – (one in twenty thousand).

Unexpected complications may require immediate treatment. They can be serious and may require more extensive surgery at a later time.

Before surgery your doctor must discuss the risks with you so when you provide consent for the operation you understand what the risks are. Don't be afraid to ask questions.

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