Endometriosis and Laparoscopy

The inner lining of the uterus consists of a tissue called endometrium, which is often shed off during menstruation. Some women suffer from a painful condition whereby endometrial tissue abnormally grows outside the uterus. This condition is called endometriosis, and endometrial implants may be found anywhere in the pelvic region, usually the ovaries, the bowels or the pelvic lining.

Through a procedure called laparoscopy, endometriosis may be diagnosed surgically via a small opening in the skin. This involves the insertion of a thin instrument with a camera through a small cut in your belly. It can detect the presence of infections, cysts, fibroids, adhesions, and endometrial tissue in your abdomen and allows the surgeon to take a small sample (biopsy) for laboratory examination.

Use of Laparoscopy in Diagnosing and Treating Endometriosis

Medical management is often initially used to treat painful conditions in the lower abdomen and pelvis. However, if your condition does not improve, your doctor may advise you to undergo laparoscopy, endometriosis being sometimes considered as the cause of your problems.

Through a laparoscope, a long and thin surgical instrument that has camera at the tip, the surgeon can view the inside of your belly without having to create a wide cut in the skin. The lighted instrument can help the surgeon view your internal organs and confirm if tissues resembling the inner uterine lining (endometrium) are present outside the uterus. It also allows the surgeon to obtain tissue samples for biopsy to confirm through laboratory examination, if you are suffering from endometriosis. This is important because endometriosis can cause not only pain, but can lead to infertility and other complications.

How to Prepare

Before the laparoscopy for endometriosis procedure, preparation includes fasting from food and drinks eight hours before the procedure. It will be conducted under general, regional or local anesthesia.

What to Expect

During laparoscopy, your abdomen will be inflated with a gas (usually carbon dioxide) to push the abdominal wall away from your internal organs to give the surgeon optimal view. The laparoscope is inserted through a small skin incision and the surgeon examines the abdominal contents. A few more incisions may be made to insert other thin instruments used to move the internal structures to facilitate viewing. During laparoscopy, endometriosis may be diagnosed in around 30 to 45 minutes.

The surgeon may remove endometrial or scar tissue by cutting (excision) or destroying it using electric current (electrocautery) or a laser beam.

At the end of the procedure, the abdominal incisions are closed using a few stitches, which usually do not lead to scarring.

Laparoscopy Before and After Tips

Talk to your doctor about the advantages and risks of the procedure.

  • Laparoscopy for endometriosis is an outpatient procedure, but you may be asked to stay overnight if surgery was complicated or lengthy. Your hospital stay may even be extended if complications like bowel nicking or heavy bleeding occurred. It is best to go to the hospital with a family member or friend who can assist you and drive you home after your discharge from the hospital.
  • Keeping these considerations in mind, prepare things that you should you take to the hospital, such as toiletries, loose clothing, sock and slip-on shoes or slippers. Your surgeon will order a bowel prep the night before surgery to evacuate the contents of your bowels.
  • After the procedure, you will be placed in the recovery room where you will be monitored until your anesthesia wears off. You may experience pain and shivering, as well as other symptoms like nausea. Tell your nurse or doctor about these so they can make you more comfortable.
  • Some women experience shoulder pain caused by trapping of gas under the diaphragm. This is often relieved by heat application and analgesics.
  • Nausea is common after laparoscopy. This may be relieved by lying flat and taking medications or ginger tea.
  • You may feel tired and sleepy for two to three days after laparoscopy, so it is best to have someone assist you with your meals and medications. While you are recuperating, you may be advised to avoid driving, swimming, bathing in a tub or having sex. You may need some rest, but it is also best to try to move about to hasten your recovery.
  • You may initially experience some numbness or pain on the incision site, but these will improve after a few days when your body heals. However, you must report any redness, swelling, increased bleeding or knots on your incision site.
  • Your menstruation following laparoscopy for endometriosismay vary. You may experience pain and heavy bleeding, but do not worry because your body is still in the healing process. Contact your doctor if the pain is persistent and severe.

FAQs on Endometriosis and Laparoscopy

Q: Why do I need to have laparoscopy for endometriosis?

A: The diagnosis of endometriosis can only be done by laparoscopy. A combination of medical and surgical treatment may be needed because endometriosis is an unpredictable disease, which can affect your fertility.

Q: Will I ever need another laparoscopy?

A: Most women do not require another laparoscopic procedure in the future, but in some women who have undergone laparoscopy, endometriosis may recur, necessitating another procedure.

Q: Will I need to have my uterus removed?

A: Removal of the uterus (hysterectomy) is not necessary, as treatments usually aim to preserve your fertility.

Q: Will I be able to get pregnant?

A: Infertility can occur in women with endometriosis that causes severe changes in the ovaries and fallopian tubes. With early laparoscopy, endometriosis should not cause infertility.

Q: Should I get pregnant soon to cure endometriosis?

A: Some women believe that getting pregnant can cure endometriosis, but this is just a myth.

Q: How long do I need to be followed for endometriosis?

A: Endometriosis is a long-term condition that has no cure. It requires long–term treatment and follow–up, especially during a woman’s childbearing years. Medications may be prescribed to control your symptoms and you may be asked to return for follow-up visits.

Q: Is laparoscopy more effective than laparotomy?

A: Laparoscopy is less invasive than laparotomy, but they are equally effective. The recurrence rates for both procedures are similar, but women who undergo laparoscopy usually experience a less painful and more rapid recovery. Talk to your doctor about the advantages and risks of each technique.

Q: What can be done to reduce the likelihood of forming new adhesions?

A: Adhesions or fibrous bands that abnormally connect separate structures usually develop after surgery. Some patients who undergo laparoscopy for endometriosis form adhesions at the site of the surgery, which may cause infertility, pelvic pain, or small bowel obstruction.

Preventive treatments during surgery can help prevent formation of adhesions. These include using special solutions to rinse the pelvic cavity after surgery and placing a protective material to act as barrier that will keep surfaces from rubbing together. This barrier eventually dissolves and gets absorbed by the body.

In some cases, additional surgery will be needed to remove adhesions formed after laparoscopy. 

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