Surgery for endometriosis aims to remove as many implants, cysts, endometriomas and adhesions as possible, and to repair any damage caused by the condition.  In the case of a hysterectomy, it aims to cure the disease by removing the uterus, and sometimes the ovaries as well. The main surgery options for endometriosis are:

• Laparoscopy

• Laparotomy

• Hysterectomy

• Combined Treatment

Laparoscopy

Laparoscopic surgery (keyhole surgery) is an operation that can remove the endometriotic patches or nodules to reduce symptoms and improve fertility. Originally the laparoscopy was only performed as a means of diagnosing endometriosis; however it has now also become the main way  of surgically treating the condition – either at the time of diagnosis or at a later date. Laparoscopic surgery can be performed in most women but it is recommended that surgery be performed by a specifically trained laparoscopic surgeon.

During laparoscopic surgery, implants, cysts, nodules and adhesions may be excised (cut out) or diathermied (burnt). Laser surgery has been used in the past, but is rarely used today. Complex surgery may also involve removal of bowel containing endometriosis. Complex surgery is performed by a specialist gynaecologist trained in this surgery.

Laparotomy

A laparotomy (an open operation requiring a cut in the skin) is a major operation which may be necessary if endometriosis is severe and extensive or if because of previous abdominal surgery, laparoscopic surgery is not an option. As well as the removal of implants, small cysts and adhesions, an operative laparoscopy or a laparotomy  may also be performed to:

• Remove large cysts and endometriomas

• Remove an ovary / ovaries  and uterine (Fallopian) tubes

• Surgically repair any damaged organs
  

Hysterectomy

A hysterectomy for endometriosis is a major operation which involves the removal of the uterus and as many remaining endometrial implants and adhesions as possible.  It may also involve the removal of one or both of the ovaries and uterine (Fallopian) tubes.

Hysterectomy is necessary when longstanding severe endometriosis has not responded to previous repeated treatments and surgery in women experiencing ongoing severe chronic pain. In most cases the ovaries are removed, which leads to early menopause. If you retain your ovaries you will not go through early menopause. However, there will be a greater likelihood that your endometriosis will persist or recur, as any remaining endometrial implants may continue to be stimulated to grow by the oestrogen produced by your ovaries.

For more information see the Early Menopause website  

Hormone therapy (HT) will prevent or reduce the effects of early menopause. However, it may also slightly increase the likelihood that you will have a persistence or recurrence of your endometriosis due to the small amounts of oestrogen taken or absorbed during the therapy.  

If you decide to take HT it is sometimes recommended that you wait three to six months after your hysterectomy before you begin treatment. This delay should allow any remaining endometrial implants to degenerate and waste away, thus reducing the chances of a persistence or recurrence of your endometriosis.  However, symptoms may be so severe that treatment becomes necessary.  Ask your health practitioner to refer you to a specialist clinic or centre for early menopause management.

For more information see Hysterectomy on the Health for Women website 

Combined treatment

Combined treatment involves a course of hormonal treatment before or after surgery to enhance the effects of surgery.

Content Updated March 06, 2008