Endometriosis Surgery

What is endometriosis surgery?

Endometriosis surgery can diagnose and treat endometriosis — a condition in which tissue that typically grows inside of your uterus grows outside of it instead.

Is endometriosis surgery a major surgery?

In most cases, no. Historically, surgeons performed open surgery — which requires a large incision across your abdomen — to remove endometriosis. Today, however, almost everyone who needs endometriosis surgery can have laparoscopy, a minimally invasive surgery which only requires small incisions.

What are the different types of endometriosis surgery?

Endometriosis surgery involves the removal of endometriosis. There are two different approaches:

1. Laparoscopy. This minimally invasive procedure is the most common approach to endometriosis surgery. Endometriosis laparoscopic surgery treats mild to severe cases by skilled surgeons trained in this method. During the procedure, they’ll make a small incision in your abdomen so they can insert a tiny tube with a camera (laparoscope) through it. In some cases, they may need to make more than one small incision.
2. Laparotomy. Healthcare providers don’t use this open surgery approach as often as they used to. Laparotomy is more invasive than laparoscopy. It involves making one large incision across the abdomen, rather than a few small incisions. Your surgeon might perform laparotomy when the condition is severe or when you don’t qualify for laparoscopy.

Who needs endometriosis surgery?

A healthcare provider can help determine whether or not you need endometriosis surgery. Surgery may be beneficial if:

• You have chronic (long-standing) or severe pelvic pain.
• You need to remove areas of endometriosis in your pelvic area.
• Medication no longer relieves your endometriosis symptoms.
• You have difficulty getting pregnant.

What should I expect before endometriosis surgery?

Your healthcare provider will give you specific instructions on how to prepare for endometriosis surgery. Here are some general guidelines:

• Make arrangements for a trusted friend or family member to drive you to and from your appointment.
• Avoid eating and drinking after midnight the night before your surgery.
• Ask your healthcare provider if you should stop taking any medications, such as blood thinners.
• If you smoke, quit smoking at least three weeks before your endometriosis surgery.
• Stock your pantry with lots of fluids and light foods like soup and gelatin.

What happens during endometriosis surgery?

As mentioned above, there are two types of endometriosis surgery: laparoscopy and laparotomy. However, the majority of people who need this surgery will undergo laparoscopy.

During laparoscopic endometriosis surgery:

• An anesthesiologist will place you under general anesthesia and monitor your vital signs.
• A surgeon will create a small incision (cut) in your bellybutton or another part of your abdomen (in some cases, they might need to make more than one incision).
• They’ll use gas to inflate your belly so the laparoscope has a clear view.
• Your surgeon will insert the laparoscope through the incision.
• They’ll use the laparoscope to find areas of endometriosis.
• They’ll attach special instruments to the laparoscope to remove any affected tissue.
• After your surgeon removes the endometrial tissue, they’ll remove the laparoscope and the instruments.
• Finally, they’ll close the incisions with stitches.

What happens after endometriosis surgery?

If you had laparoscopy, you’ll probably go home from the hospital on the same day. But you’ll need to rest in a recovery area until your medical team clears you. You’ll likely feel tired for a few days. But you should be able to return to normal routines in about two weeks, though it could take longer for some people.

People who undergo laparotomy usually need several weeks to recover because the procedure is more invasive. Your healthcare provider will give you a list of detailed post-operative guidelines.

Does surgical treatment improve pain?

Most people notice significant relief with simple removal of the endometriosis. However, 20% of those who undergo surgery won’t respond and will need further medical treatment. Of those that respond, there may be a recurrence (return) of pain over time.

What factors determine whether endometriosis comes back after surgery?

Whether endometriosis comes back (recurs) after surgery depends upon three factors:

• How severe the disease was at the time of surgery.
• How completely the surgery removed the lesions.
• Whether you had medical suppressive therapy after your surgery.

Lesions that appear after surgery may be new or pre-existing. For this reason, it may be difficult for your provider to tell whether your disease has come back or is progressing. Many studies also report symptoms as a sign of new disease.

Is laparoscopy more effective than laparotomy?

Laparoscopy is superior to laparotomy because it results in fewer surgical complications, such as bleeding, infection and possible injuries to other abdominal organs. Laparoscopy also offers faster recovery and less downtime compared to laparotomy.

What are the risks or complications of endometriosis surgery?

Endometriosis surgery is relatively safe. However, as with any procedure, there are possible complications, including:

• Infection.
• Bleeding.
• Possible injury to nearby organs such as your bladder and bowel.
• Fistula (an abnormal connection between two organs).
• Blood vessel damage.

What’s the outlook for people who undergo endometriosis surgery?

While many people find success with medication and surgery, these treatments do have side effects and they don’t work for everyone. Researchers are continuing to investigate new and improved treatment strategies. One area of study is focusing on the role of the immune system in the development of endometriosis.

How long does it take to recover from endometriosis surgery?

People with advanced cases of endometriosis may need six weeks or longer to recover. If you have mild endometriosis, you may heal quicker.

When can I go back to work or school after endometriosis surgery?

Unless you have a physically demanding job, you’ll probably be able to return to work or school two weeks after endometriosis surgery. If your job requires a lot of physical activity, you may need to wait longer. Be sure to ask your healthcare provider what to expect in terms of your recovery.

When should I contact my healthcare provider?

Following endometriosis surgery, you should call your healthcare provider if you notice:

• Redness or swelling around the incision sites.
• A fever of 101°F or higher.
• Pain that worsens or doesn’t improve with medication.
• Pus draining from the incision site.
• Heavy bleeding from your vagina.
• Feeling as though you can’t empty your bladder.

Can endometriosis come back after surgery?

Surgery is usually successful in relieving pain, but there’s a chance the pain could return. Hormones produced by your ovaries stimulate endometriosis. To combat this, your healthcare provider may recommend medication (such as birth control pills, or progesterone-only medications) to suppress your ovaries and control endometriosis.

How quickly can endometriosis grow back after surgery?

Endometriosis can grow back soon after surgery if the disease isn’t completely removed or if your ovaries aren’t suppressed.

Does endometriosis surgery help fertility?

In many cases, endometriosis surgery can improve your chances of getting pregnant naturally. However, if you don’t get pregnant within a reasonable timeframe following your procedure, having surgery again probably won’t help.

Treating early stage endometriosis to improve fertility is controversial. If you have questions about endometriosis and fertility, talk with a healthcare provider about personalized treatment.

A note from Cleveland Clinic

Endometriosis can be a painful and frustrating condition. If you think you may have endometriosis, schedule a consultation with your healthcare provider. They can design an individualized treatment plan to ease your symptoms and improve your quality of life.