Laparoscopic Surgery for Diagnosis and Treatment of Endometriosis

Endometriosis is a condition that affects women in their reproductive years, impacting more than 70 million women worldwide, with an estimated five million of them living in the United States.

What Causes Endometriosis?

The cause of endometriosis is unknown, although there are some theories that it may be caused by menstrual flow backing up through the fallopian tubes and settling in the pelvic cavity where the tissues adhere to various organs. Another possibility is coelomic metaplasia, a situation in which areas lining the pelvic organs contain primitive cells that are able to grow into other forms of tissue, like endometrial cells. It is possible that endometrial tissues are directly transferred during a surgery, such as an episiotomy or cesarean delivery. This concept comes from the noted presence of endometriosis implants seen in surgical scars. Some studies have shown that the immune system of a woman with endometriosis is altered, which may affect the natural ability of the body to identify and destroy errant endometrial tissue.

How Do I Know If I Have It?

Although most women who have endometriosis do not have overt symptoms, those who do have them commonly experience abdominal pain - especially bad at the time of menstruation - and infertility. Pain intensity can change from month to month and it can vary greatly among women. For some women, the pain becomes progressively worse and for others it dissipates without treatment. Often a woman has no idea she has endometriosis until she tries to become pregnant. Laparoscopy, sometimes done to discover the cause of infertility, is also a means by which endometriosis is diagnosed. Some women find out they have endometriosis during a laparoscopic procedure for infertility.

When Should I Consider Surgery?

Endometriosis can be treated with hormone drugs if the condition is not too severe. If it is more serious, then surgery is the recommended treatment. Surgical treatment for endometriosis is usually performed in one of the following situations:

· At the time of diagnosis for mild to moderate endometriosis

· If drug therapy was ineffective

· If there are fertility issues

· Moderate to severe endometriosis

· When endometriosis returns

Surgery for endometriosis can be very radical, as in the case of a complete hysterectomy, or it can be more conservative with the intention of restoring the appearance of the pelvis to normalcy. When the surgery is conservative, the method used is a laparoscopy, the same type of surgery done to diagnose the problem. Often the doctor will do the laparoscopic surgery at the same time he or she is making the diagnosis to avoid a second surgery.

How Is Laparoscopic Surgery Performed?

A laparoscopy allows the doctor to look inside the abdomen and pelvic area and observe the health of the pelvic cavity. The diagnostic laparoscopy is generally done as an out-patient procedure and it is performed under anesthetic. A tiny incision is made in the abdomen, the belly is inflated with gas, usually carbon dioxide, and then the long, thin laparoscope is inserted into the abdominal cavity. A light is attached to this telescopic tool so the doctor can see what is going on. The same procedure is done to surgically treat endometriosis. To do this, a second small incision is required lower down on the abdomen in order for additional surgical instruments to be inserted. These instruments can be used to treat endometrial growths by removing them, separating adhesions as well as draining and treating large cysts.

Different instruments are required to perform the various repairs to damaged tissue and organs affected by endometriosis. Diathermy, a process that uses electric current may be employed to divide tissue or seal blood vessels to control bleeding. Lasers are very precise and do not cause a lot of tissue damage. They may be used to burn endometrial cysts and to cut away adhesions.

Laparoscopic surgery has a much faster recovery period and has less post-operative discomfort than conventional surgery.


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