Surgical Approaches

If a woman has moderate to severe endometriosis, surgery may be necessary. A doctor removes as much misplaced endometrial tissue as possible, while preserving the woman's ability to have children. Often, the tissue is removed during laparoscopy when the diagnosis is made. Surgery is usually necessary for patches of endometrial tissue larger than 11/2 to 2 inches in diameter, for significant adhesions in the lower abdomen or pelvis, and for endometrial tissue that obstructs one or both fallopian tubes or that's causing extreme lower abdominal or pelvic pain unrelieved by drugs. Sometimes electrocautery (a device that uses an electrical current to produce heat) or a laser is used to remove endometrial tissue. However, surgical removal is only a temporary measure; endometriosis recurs in most women.

The advantages of this surgical approach, besides a shorter and less expensive hospital stay, include less likelihood of complications; reduced tissue injury, bleeding, and scar tissue formation; rapid diagnosis and treatment; and an easier, swifter, less painful recovery. The risks it carries are mainly those of instrument insertion and heat injury plus potential anesthetic complications. Meanwhile, it directly attacks the causes of pain and infertility, the most important concerns  women have about endometriosis.

Laparotomy involves opening up the abdominal cavity. It is called for when endometriosis is so widespread (and perhaps accompanied by other related diseases) that it can't be handled through the tiny incision used in laparoscopic surgery. Appendix, bladder, bowel, and kidney involvement, for example, may require special surgical techniques only practical with laparotomy. If there are large cysts to be removed (not uncommon in endometriosis), this is often manageable only with laparotomy. The same is true of large endometrial growths that form a mass involving a number of organs.

Many other operations and related tests may be performed to deal with specific problems during treatment for endometriosis. Among them are: