Endometriosis is a condition where tissue similar to the lining of the uterus, known as the endometrium, grows outside the uterus. This misplaced tissue can be found on organs such as the ovaries, fallopian tubes, and the outer surface of the uterus. It can lead to symptoms like chronic pelvic pain, painful menstrual periods, discomfort during sexual activity, and infertility. Excision surgery is a primary treatment approach for managing endometriosis.
Understanding Excision Surgery
Excision surgery involves the precise removal of endometriotic lesions. This surgical technique focuses on cutting out the entire lesion, including any underlying roots, rather than simply burning or vaporizing the surface. The goal is to remove the diseased tissue while preserving the surrounding healthy tissue and organ function.
This approach differs from ablation, which involves burning or coagulating the surface. While ablation can reduce symptoms temporarily, it may leave behind deeper portions of the disease, potentially leading to faster recurrence or incomplete relief. Excision aims for complete removal, which can lead to better long-term outcomes and symptom improvement. Procedures are performed by gynecological surgeons who specialize in endometriosis.
Goals of Excision Surgery
The primary objective of excision surgery is to alleviate pain associated with endometriosis. By removing the lesions, the surgery can reduce chronic pelvic pain, painful menstrual cycles, and discomfort during intercourse. This targeted removal helps to diminish the inflammatory response caused by the misplaced endometrial-like tissue.
Excision surgery also aims to improve fertility for those with endometriosis-related infertility. Removing implants and adhesions can restore the normal anatomy of the reproductive organs, making it easier for sperm and egg to meet and for implantation to occur. The procedure also seeks to restore the normal anatomical relationships of pelvic organs by freeing them from adhesions, which are bands of scar tissue that can distort organ positions. Removing lesions can help prevent the disease from progressing and causing further damage to pelvic structures. Ultimately, the surgery aims to enhance a patient’s overall quality of life.
The Surgical Procedure
Excision surgery is commonly performed using a minimally invasive laparoscopic approach. This involves making a few small incisions in the abdominal wall. A thin, lighted tube with a camera, called a laparoscope, is inserted through one incision to provide a magnified view of the pelvic organs on a monitor. Specialized surgical instruments are then inserted through the other small incisions.
The surgeon identifies all visible endometriotic implants and cuts them out using various techniques, such as sharp dissection or energy devices. For deep infiltrating endometriosis, which involves lesions that have penetrated deeply into organs like the bowel or bladder, additional surgical expertise from colorectal or urological surgeons may be required. Once all identified lesions are removed, the small incisions are closed with sutures or surgical tape. The procedure is performed under general anesthesia.
Post-Operative Recovery
After excision surgery, patients are often discharged the same day or the following morning. Immediate post-operative experiences may include mild to moderate pain, managed with prescribed pain medication. Nausea from anesthesia is also common and managed with medication. Common symptoms during recovery include shoulder pain, which results from residual carbon dioxide gas used to inflate the abdomen during surgery, and general abdominal discomfort. Light vaginal bleeding or spotting is also normal for a few days.
Patients are advised to limit strenuous activities, heavy lifting, and intense exercise for several weeks. Most individuals can return to light activities and work within one to three weeks, with full recovery taking up to six weeks or longer depending on the extent of the surgery. Adhering to the surgeon’s post-operative instructions is important for optimal healing.
Managing Endometriosis After Excision
Following excision surgery, ongoing management is important because endometriosis is a chronic condition. Regular follow-up appointments with a healthcare provider specializing in endometriosis are recommended to monitor symptoms and discuss any concerns. While excision aims to remove lesions, new ones can form over time, meaning that recurrence of symptoms is possible, though often delayed.
Some patients may benefit from additional therapies after surgery to manage symptoms or reduce the likelihood of recurrence. These can include hormonal medications that suppress the growth of endometrial-like tissue or lifestyle adjustments. Maintaining open communication with the healthcare provider allows for continuous assessment of symptoms and adjustment of the management plan as needed.