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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 severe cases, a hysterectomy aims to cure the disease with the removal of the ovaries. Sometimes one or both ovaries are left but there is a risk of recurrence of the endometriosis is severe.
The main surgery options for endometriosis are:
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 become the main way of surgically treating the condition – either at the time of diagnosis or at a later date.
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 or bladder containing endometriosis. Complex surgery is usually performed by a specialist laparoscopic gynaecologist with or without a specialist bowel surgeon or urologist respectively.
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:
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Remove large cysts and endometriomas
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Remove an ovary / ovaries and uterine (Fallopian) tubes
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Surgically repair any damaged organs
Hysterectomy
A hysterectomy (removal of the uterus) 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 (a salpingo-oophorectomy).
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 replacement therapy (HRT), normally estrogen-only therapy (ET), will prevent or reduce the effects of early menopause. However, there may be a small risk that you will have a persistence or recurrence of your endometriosis due to the small amounts of oestrogen taken or absorbed during the therapy.
Sometimes it is recommended that you wait three to six months after your hysterectomy before you begin HRT. This delay may lead to any remaining endometrial implants degenerating and wasting away, 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. One type of HRT, called Tibolone, may be suitable as it does not stimulate endometrial celles in the same way as standard HRT does.
Combined treatment
Combined treatment involves a course of hormonal treatment before or after surgery to enhance the effects of surgery.
Content Updated August 31, 2009
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