Endometriosis Surgery

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Endometriosis surgery

        Although hormone therapy is effective in eliminating symptoms of endometriosis, it prevents a pregnancy. For patients who desire a pregnancy, surgery to remove implants is the best choice. Endometriosis is indicated when patients are facing with severe pain caused by endometriosis.

       Conservative surgery can be performed by laparoscopy or through traditional abdominal surgery in severe cases. In laparoscopic surgery, a thin tube (laparoscope) equipped with a laser and cautery - an instrument that destroys tissue by burning - is inserted through a small incision which is made below the navel.

       The surgical treatment by laparotomy has long represented "the treatment" of endometriosis, whether conservative or radical.

Endometriosis surgery methods

        It is common to oppose the conservative techniques and techniques that can lead to non-conservative surgery truly radical.

• Conservative surgery
• It is primarily intended for patients requiring the improvement of their infertility or those wishing to preserve it, but can also be used for the treatment of some pain and ovarian endometriomas.
• Whether done with or without magnification it must respect the fundamental principles well established and known for tubal microsurgery: atraumatism, preservation of reefs above normal, fine hemostasis, permanent irrigation, use of fine sutures , anatomical reconstruction.
• The conservative non-surgical
• Endometriosis surgery is necessary for resected lesions.

Endometriosis surgery pictures

Endometriosis surgery genital lesions

        Depending on location, special measures must be ensured.

• Peritoneal lesions
• The implanted surface are usually easily resected. The laser can also be used to destroy the lesions. The implants must be completely resected and are often more important than they seemed; dissection, the protection of sub-peritoneal noble organs is sometimes necessary (urethra, rectum ...).
• Lesions adhesions
• The adhesions are released carefully, taking care to preserve the peritoneum. The shoulders between dense bodies are often more difficult to manage and again peritoneal grafts may be used.
• Ovarian lesions
• At the ovarian level, it must be removed all the lesions to prevent recurrence, but also maintain the maximum healthy parenchyma. Microsurgery is often useful to make a finer dissection, especially in cases of bilateral disease.
• Endometriosis cyst are resolved through an endometriosis surgery called cystectomy.
• Tubal lesions
• Proximal tubal obstruction by endometriosis lesion is treated like any other obstructions to this level, preferably by microsurgery.

Endometriosis surgery extragenital lesions

        They are varied and require a specific endometriosis surgery for each organs involved. The rate of improvement in pain ranged from 41-75%, but recurrence rates up to 25% at 40 months. Sometimes, a neurectomy has been associated. Radical surgery is considered for its cure rate of close to 100%. In cases of infertility, there is also great variability of results and it is not surprising for all the reasons which have been indicated. Microsurgical benefits are clearly superior to that of conventional surgery.

        Current indications for surgery by laparotomy, apart from some extra-genital lesions, is dependent on the experience in laparoscopic surgery of the operator. They are rare in the expert hands and trained more frequent for others. In cases where endometriosis surgery is incomplete, expediency of further medical treatment should be discussed. Microsurgery helps maintain a maximum of ovarian parenchyma healthy.

        Radical surgery is reserved for the most severe cases. It represents the last resort. Ovarian hysterectomy cases arise, but we know it increases the risk of recurrence with reported rates ranging from O to 85%.

        Some doctors have completely abandoned traditional endometriosis surgery in favor of laparoscopy, while others believe the contrary that there is not enough scientific data available for laparoscopy on its efficacy and safety for severe endometriosis and could not be recommended surgery by laparotomy. Microsurgery is better for treating proximal tubal obstructions and large bilateral endometriomas.