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Endometriosis has been estimated to affect up to 10% of women. Approximately four out of every 1,000 women are hospitalized as a result of endometriosis each year. Women ages 25–35 are most affected, with 27 being the average age at diagnosis. The incidence of endometriosis is higher among white women and among women who have a family history of the disease.
The patient is given anesthesia before the procedure commences. The method of anesthesia depends on the type and duration of surgery, the patient's preference, and the recommendation of the physician. General anesthesia is most common for operative laparoscopy, while diagnostic laparoscopy is often performed under regional or local anesthesia. A catheter is inserted into the bladder to empty it of urine; this is done to minimize the risk of injury to the bladder.
A small incision is first made into the patient's abdomen in or near the belly button. A gas such as carbon dioxide is used to inflate the abdomen to allow the surgeon a better view of the surgical field. The laparoscope is a thin, lighted tube that is inserted into the abdominal cavity through the incision. ../images taken by the laparoscope may be seen on a video monitor connected to the scope.
For this procedure, three or four incisions may be made in the woman's lower abdomen (A). Carbon dioxide is pumped into the abdomen to create a condition called pneumoperitoneum, which gives the surgeon more room to work (B). A laparoscope with video monitor is used to view the internal structures, while endometrial growths are removed with other tools (C).
The surgeon will examine the pelvic organs for endometrial growths or adhesions (bands of scar tissue that may form after surgery or trauma). Other incisions may be made to insert additional instruments; this would allow the surgeon to better position the internal organs for viewing. To remove or destroy endometrial growths, a laser or electric current (electrocautery) may be used. Alternatively, implants may be cut away with a scalpel (surgical knife). After the procedure is completed, any incisions are closed with stitches.
Some of the symptoms of endometriosis include pelvic pain (constant or during menstruation), infertility, painful intercourse, and painful urination and/or bowel movements during menstruation. Such symptoms, however, are also exhibited by a number of other diseases. A definitive diagnosis of endometriosis may only be made by laparoscopy or laparotomy.
Prior to surgery, the patient may be asked to refrain from eating or drinking after midnight on the day of surgery. An intravenous (IV) line will be placed for administration of fluids and/or medications.
After the procedure is completed, the patient will usually spend several hours in the recovery room to ensure that she recovers from the anesthesia without complication. After leaving the hospital, she may experience soreness around the incision, shoulder pain from the gas used to inflate the abdomen, cramping, or constipation. Most symptoms resolve within one to three days.
Risks that are associated with laparoscopy include complications due to anesthesia, infection, injury to organs or other structures, and bleeding. There is a risk that endometriosis will reoccur or that not all of the endometrial implants will be removed with surgery.
After laparoscopy for endometriosis, a woman should recover quickly from the surgery and experience a significant improvement in symptoms. Some studies suggest that surgical treatment of endometriosis may improve a sub-fertile woman's chance of getting pregnant.
Morbidity and Mortality Rates
The overall rate of risks associated with laparoscopy is approximately 1–2%, with serious complications occurring in only 0.2% of patients. The rate of reoccurrence of endometrial growths after laparoscopic surgery is approximately 19%. The mortality rate associated with laparoscopy is less than five per 100,000 cases.
While laparoscopy remains the definitive approach to diagnosing endometriosis, some larger endometrial growths may be located by ultrasound, a procedure that uses high-frequency sound waves to visualize structures in the human body. Ultrasound is a noninvasive technique that may detect endometriomas (cysts filled with old blood) larger than 0.4 in (1 cm).
A physician may recommend noninvasive measures to treat endometriosis before resorting to surgical treatment. Over-the-counter or prescription pain medications may be recommended to relieve pain-related symptoms. Oral contraceptives or other hormone drugs may be prescribed to suppress ovulation and menstruation. Some women seek alternative medical therapies such as acupuncture, management of diet, or herbal treatments to reduce pain
Severe endometriosis may need to be treated by more extensive surgery. Conservative surgery consists of excision of all endometrial implants in the abdominal cavity, with or without removal of bowel that is involved by the disease. Semi-conservative surgery involves removing some of the pelvic organs; examples are hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries). Radical surgery involves removing the uterus, cervix, ovaries, and fallopian tubes (called a total hysterectomy with bilateral salpingo-oophorectomy).
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