The Times Australia
The Times World News

.
Times Media

.

I'm thinking of surgery for endometriosis. What's involved? Does it work?

  • Written by Mike Armour, Senior research fellow in reproductive health at NICM Health Research Institute, Western Sydney University
I'm thinking of surgery for endometriosis. What's involved? Does it work?

Endometriosis is a painful condition caused by the presence of tissue similar to the lining of the uterus found outside the uterus. It affects around one in nine women[1] and people assigned female at birth.

Common symptoms[2] include painful periods, pelvic pain, fatigue, pain with sexual intercourse, pain while urinating or passing bowel motions, and infertility.

While mild endometriosis involves superficial deposits on or around the reproductive organs, severe endometriosis causes nodules and adhesions – bands of scarring that can attach organs to each other.

There’s currently no known cure for endometriosis. Symptoms can be managed with surgery[3], medications, hormonal treatments, pelvic physiotherapy and complementary therapies such as acupuncture.

Read more: You no longer need surgery to be diagnosed with endometriosis. Here's what's changed[4]

What happens during surgery?

Endometriosis surgery is usually performed by laparoscopy or keyhole surgery. Most people will have a camera inserted through the belly button and three to four other incisions (about half a centimetre across) for other instruments to cut, grab, burn and hold.

The first step is to look around for abnormalities. Surgeons will look for endometriosis in the pelvis, abdomen, and under the diaphragm. They will look in, around and under every possible fold of tissue.

Surgeons use[5] two different techniques to treat endometriosis:

1) excision involves cutting out endometriosis. The aim is to remove as much of the visible endometriosis as possible and repair any damage it may have caused. Excised lesions can be examined under a microscope to see if endometrial-like cells are present to confirm diagnosis, which is not possible with ablation

2) ablation attempts to destroy the endometriosis where it lies, using heat energy.

Woman holder her belly, which has dressings from a laparoscopy
Small incisions are made in the patient’s abdomen for the camera and instruments. Shutterstock[6]

Since most surgeries are laparoscopic, many centres discharge patients home on the same day.

Recovery after surgery varies. Within a few weeks, some people are back to relatively regular activities like work, household duties, and socialising. Most people who have laparoscopic surgery will feel almost back to normal by six weeks after their operation.

Which surgical technique is better?

Some evidence[7] suggests excision surgery may be better than ablation at reducing pain during sexual intercourse.

However, overall, several[8] recent[9] meta-analyses (a type of study that combines the results of many clinical trials) concluded there is little-to-no difference in most symptoms between ablation and excision at 12 months after surgery.

Many surgeons use excision, as this can remove the lesions as completely as possible. However, there may be circumstances where the lesions may be more suitably treated with ablation – for instance, to remove endometriosis on the surface of the uterus, ovary or fallopian tube – where excision may cause more harm.

Read more: I have painful periods, could it be endometriosis?[10]

How effective is surgery?

Clinical guidelines in Australia and New Zealand[11] and Europe[12] recommend laparoscopic surgery be offered as one way to reduce pain[13] from endometriosis. This is based on evidence that it successfully reduces pain. However, the current quality of evidence assessing the effectiveness of surgery in reducing pain is low because the studies were small and didn’t follow participants for long.

For treating infertility, there may be some benefit[14] to surgically treating endometriosis, but it’s impossible to say exactly how much[15].

Often, people may seek assisted reproductive therapies (ART) such as IVF. However, there is little research comparing whether surgery or IVF is more effective at achieving the goal of a live birth.

The risks[16] and benefits of surgery and ART differ based on the individual circumstances.

Woman holds pregnancy test
Women with endometriosis may use IVF to conceive. Cottonbro Studio/Pexels[17]

What happens after surgery?

After the recovery period, patients will be able to assess how their symptoms have changed.

They may need to continue to use or start other strategies to manage pain. While surgery can reduce inflammation pain associated with endometriosis lesions, it may be less effective for treating pain from the pelvic floor muscles that may be short, tight, or tender.

Read more: Considering surgery for endometriosis? Here's what you need to know[18]

In some people, endometriosis symptoms resolve after surgery, then sometimes return. After[19] five years[20], 15-56% of people[21] who had surgery for endometriosis experience a recurrence of symptoms.

This may be due to new lesions developing or growth of residual disease[22] if the previous endometriosis lesions were not completely removed, were overlooked or not detected.

In some cases, it may be due to other gynaecological conditions. Or it may represent a change in the nervous system, often due in part to endometriosis, called central sensitisation.

Part of the problem is the definition of “recurrence” is inconsistent[23] and ranges from pain symptoms returning (with an assumption they must be due to endometriosis recurring) to endometriosis lesions actually being seen again (by imaging or repeat surgery).

Ultimately, any health decision is an intimately personal decision and people have to weigh the pros and cons after speaking with their doctors.

References

  1. ^ around one in nine women (pubmed.ncbi.nlm.nih.gov)
  2. ^ Common symptoms (www.nature.com)
  3. ^ surgery (doi.org)
  4. ^ You no longer need surgery to be diagnosed with endometriosis. Here's what's changed (theconversation.com)
  5. ^ Surgeons use (doi.org)
  6. ^ Shutterstock (www.shutterstock.com)
  7. ^ Some evidence (dx.doi.org)
  8. ^ several (doi.org)
  9. ^ recent (doi.org)
  10. ^ I have painful periods, could it be endometriosis? (theconversation.com)
  11. ^ Australia and New Zealand (ranzcog.edu.au)
  12. ^ Europe (www.eshre.eu)
  13. ^ reduce pain (doi.org)
  14. ^ benefit (www.sciencedirect.com)
  15. ^ how much (www.jmig.org)
  16. ^ risks (obgyn.onlinelibrary.wiley.com)
  17. ^ Cottonbro Studio/Pexels (www.pexels.com)
  18. ^ Considering surgery for endometriosis? Here's what you need to know (theconversation.com)
  19. ^ After (doi.org)
  20. ^ five years (doi.org)
  21. ^ people (doi.org)
  22. ^ disease (doi.org)
  23. ^ inconsistent (doi.org)

Read more https://theconversation.com/im-thinking-of-surgery-for-endometriosis-whats-involved-does-it-work-182509

The Times Features

Designer Wardrobe reports surge in pre-loved wedding gowns

As Australia’s wedding season approaches, and amidst a challenging cost of living backdrop, new insights from Designer Wardrobe reveal that Australia and New Zealand (ANZ) brid...

DIY Bathroom Remodel: Essential Tips for a Fresh Look

As the home improvement craze continues to grow, more folks are diving into the world of DIY projects to transform their living spaces. Among these, bathroom remodels have gain...

STI rates are increasing among midlife and older adults. We need to talk about it

Globally, the rates of common sexually transmissible infections[1] (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger pe...

The Gift That Keeps Growing: Why Tinybeans+ Gift Cards are a game-changer for new parents

As new parents navigate the joys and challenges of raising a child in the digital age, one question looms large: how do you preserve and share your baby's milestones without co...

Group Adventures Made Easy: How to Coordinate Shuttle Services from DCA to IAD

Traveling as a large group can be both exciting and challenging, especially when navigating busy airports like DCA (Ronald Reagan Washington National Airport) and IAD (Washington...

From Anxiety to Assurance: Proven Strategies to Support Your Child's Emotional Health

Navigating the intricate landscape of childhood emotions can be a daunting task for any parent, especially when faced with common fears and anxieties. However, transforming anxie...

Times Magazine

Stand Out Online: Affordable Websites Win!

Definitely, in the era of digital media, owning a website is not just a nice-to-have thing but a compulsion. It's your stall for sales on a global bazaar, your best means to call for customers 24 hours a day & a great weapon to create public tr...

Google Ads Made Easy: Streamlining Your Online Advertising

Conquering the online marketplace in Melbourne can feel like climbing the Eureka Tower blindfolded. Yet the expanse of the Mornington Peninsula offers the perfect sanctuary for those of you who worry like me do. When used properly, Google Ads can a...

Holiday Home Hacks: 5 Tips for Beautifying Your Outdoor Living Spaces

Aussie summers are all about time spent outdoors, especially if you're lucky enough to have a holiday home in the family. With the right design choices and professional assistance for the bigger tasks, you can turn your outdoor living space into an...

Beet Pulp as a Holistic Treatment for Horse Ulcers

Equine ulcers are a common problem in horses that can cause a lack of stomach acid protection resulting in erosive damage to the stomach lining. Stressful situations such as competition, travel, changes in diet and environment, illness and injury c...

Find the Most Adorable Jellycat Toys in Singapore

Overview of Jellycat Brand Jellycat is an internationally renowned British brand of luxury soft toys and accessories that has been offering quality, comfort, and style since 1999. With its high-quality designs and attention to detail, Jellycat has...

4 Types of SEO every Business Must Embrace

There is no getting around it, if you are involved in any type of business or service then getting your online presence watertight is key to any hopes of success. Yet with 1.8 billion pages on the internet competition is fierce. So how can you sta...