Surgical Treatment for Endometriosis
Endometriosis surgical treatment principles:
1. In case of Failure of medical therapy. (Read more: Endometriosis)
2. Medical therapy contraindications.
3. Suspicion of malignancy.
4. Causing obstruction of the urinary or intestinal tracts.
Surgical treatment of endometriosis is avoided when:
1. Persistent pelvic pain even with repeated surgeries.
2. Nearing menopause.
Treatment options:
1. Conservative surgery: laparoscopic excision or ablation of Endometriosis.
a. preserves fertility.
b. less pain, quicker recovery.
c. Surgical complications: injury to adjacent structures such as nerves, blood vessels or ureters, adhesions or wound infection.
d. Laparotomy might be needed in case of endometriosis located near the uterine arteries, ureter, bladder, and bowel.
e. Symptom recurrence rate: 20 – 40%.
Risk factors for symptoms recurrence:
– Incomplete excision of endometriosis
– Ovarian cyst drainage
– Ovarian conservation
2. Definitive surgery: hysterectomy, with or without oophorectomy.
a. This procedure is:
– In case of persistent symptoms
– Failure of both medical therapy and at least one conservative treatment procedure
– With presence of other indications such as symptomatic fibroids or prolapse
b. Long-term efficacy is higher
c. Lesser need of subsequent surgery
d. Higher surgical complication rates
Oophorectomy:
It results in premature menopause.
It is advised to avoid oophorectomy in women younger than 40.
Oophorectomy benefits women who:
– With extensive adnexal disease
– The risks of repeating the operation outweigh the risks of premature menopause
Disadvantages of oophorectomy:
– Menopausal symptoms
– Increase the risk of cardiovascular disease, neurologic disease, osteoporosis, and psychiatric diseases.
– Increase the risk of mortality
3. Nerve transection procedures:
To treat endometriosis related pain.
This procedure may reduce pain but there are concerns regarding its safety.
Side effects: constipation and urinary dysfunction
Post-operation care:
To reduce symptom recurrence and avoid the need for repeating surgeries.
1. Levonorgestrel-releasing intrauterine device
2. Oral contraceptive pills (combined or progestins only)
3. GnRH analogue (nafarelin)
4. GnRH agonists, if other options were not effective
5. aromatase inhibitors
6. Hormonal therapy for menopause symptoms in case of oophorectomy
