Surgical Treatments
Drug therapy may be inadequate for treating more serious cases and in these instances we’ll recommend surgery.
Laparoscopic excision of endometriosis
Laser treatment has become fashionable in the UK for treating endometriosis. In most cases the laser is used to treat the surface of the endometriosis rather than destroying the deeper cells. This form of treatment is called ablation, whereas removal of the endometriosis, by whatever method, is called excision. Despite its futuristic connotations however ablation, even with laser, may not be the most effective treatment, as it can leave more deeply seated endometriosis cells untouched.
The Endometriosis Institute in the USA has found that cutting out all signs of the disease is preferable. This helps prevent recurrence and ensures all symptom-causing cells are removed. These can then be analysed to confirm the diagnosis. This is the approach that we recommend too.
(For more information on this subject, visit pioneering expert Dr David Redwine’s site by clicking here www.endometriosistreatment.org/html/question6.html)
Excision isn’t as drastic as it may sound. At the clinic we practise laparoscopic (key-hole) surgery, using special micro-cameras and surgical instruments inserted through a number of small incisions. The benefits include:-
- A shorter stay in hospital
- Less risk of a post-operative infection
- Less chance of scar tissue forming in the abdomen
- Smaller scars on the abdomen
- A larger, magnified view of the pelvis, allowing more precise surgery
The operation is performed under general anaesthetic and takes 2-3 hours on average. Generally you can go home the next day, provided you feel well, but if your surgery is very extensive, we may recommend you stay in hospital for longer. Once home, you’ll need to rest for 1 – 2 weeks, although this does vary from person to person. This procedure is more invasive than the standard laparoscopic procedure.
Follow up suggests that between 60 and 70% of women will have significant improvement in their pelvic pain following laparoscopic excision of endometriosis.
Naturally we’ll explain the entire process to you in detail if you need the operation. Surgery will be carried out at the BUPA Glen Hospital, Bristol – www.bupahospitals.co.uk/bristol
Additional procedures
Some women with endometriosis also have heavy, painful periods. A mirena coil can be helpful for some and can be inserted at the same time as the laparoscopic excision of endometriosis.
The presacral nerves carry pain sensation from the uterus to the brain. They run in front of the sacrum, which is the back part of the pelvis. Cutting these nerves sometimes helps to reduce severe cramping period pain.
Hysterectomy can be beneficial for women who definitely do not want further children or who are older. This is an effective treatment for some women, provided the endometriosis has not spread elsewhere.
We’ll discuss these procedures with you and together decide the best option for you.