Endometriosis and Laparoscopic Surgery Treatment
Laparoscopy Surgery for Pelvic Endometriosis and Infertility
Oct 31, 2009
For women suffering from severe pain from pelvic endometriosis, or those suffering from endometriosis related infertility, the treatment offered may be medication or laparoscopic surgery. Both have benefits; endometriosis research shows that endometriosis treament with laparoscopy surgery is effective in pain management and to decrease infertility.
Having Laparoscopic Surgery to Treat Endometriosis
Laparoscopy for endometriosis is done through several very small abdominal incisions. A lighted scope inserted through one of the incisions allows the surgeon direct visualization of the ovaries, the outside of the fallopian tubes and uterus. Patients are asleep, usually under general anesthesia, which helps relax the abdominal muscles and make it easier to get a good view.
Scar tissue (adhesions) can be removed during surgery; endometrial implants can also be removed. One problem with removing lesions is that the tissue underneath is prone to forming more adhesions. For this reason, some surgeons prefer to remove only implants that impact the most important structures, like the ovaries and fallopian tubes, rather than removing every bit of endometriosis they see.
Endometriosis Research on Treatment With Ablation or Excision
Endometrial implants can be removed either by excision (cutting them away with knives and scissors) or ablation, which destroys the tissue by use of lasers or ultra sound, but may also destroy surrounding normal tissue. Both methods have advantages and disadvantages, and surgeons generally have a preference for which technique they prefer. Endometriosis research is mixed on which is better.
One research study on endometriosis by J. Wright, H. Lotfallah, K. Jones, D. Lovell entitled “A randomized trial of excision versus ablation for mild endometriosis”, published in Fertility and Sterility, Volume 83, Issue 6, June 2005, Pages 1830-1836 showed no difference in pain relief and pregnancy rates between the two methods.
Another view is espoused by Todd Jenkins, MD, in his article “Endometriosis: The Case for Surgical Excision” which sites several studies leading to his conclusion that excision is a better technique for long term treatment of endometriosis than ablation.
Improving Chance of Getting Pregnant by Removing Endometriomas
The ovaries are the most common site of endometriosis, probably because of their close proximity to the uterus. Laparoscopic surgery for endometriosis is used to remove not only endometriosis around the ovary, but also endometriomas, also known as chocolate cysts. Endometriomas from endometriosis can cause infertility.
Removing the entire endometrioma without damaging any normal tissue is the goal, as most studies indicate that endometrioma removal helps infertility and also decreases miscarriage rate, as described in the article “Results of in vitro fertilization in patients with endometriomas: Is surgical removal beneficial?”American Journal of Obstetrics and Gynecology, Volume 191, Issue 2, Pages 597-605 by B. Wong, N. Gillman, S. Oehninger, W. Gibbons, L. Stadtmauer
Benefits of Laparoscopic Surgery as Treatment for Endometriosis
Laparascopy for endometriosis is used for both pain management and to improve pregnancy rates. The risks of surgery are minimal and recovery rapid. Endometriosis research shows that both excising endometriosis and ablation of endometriosis are effective and have benefits in reducing pain and increasing chances for pregnancy. Removing endometriomas via laparoscopic surgery also improves pregnancy rates and decreases miscarriage rate.
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