Surgical treatment of endometriosis

Surgical treatment of endometriosis

Surgical treatment for endometriosis can be useful when the symptoms of endometriosis are severe or when there has been an inadequate response to medical treatment. Surgery is the preferred treatment when there is anatomic distortion of the pelvic organs or obstruction of the bowel or urinary tract. Surgical therapies for endometriosis may be either classified as conservative, in which the uterus and ovarian tissue is preserved, or definitive, which involves hysterectomy (removal of the uterus), with or without removal of the ovaries.
Conservative surgery is typically carried out by laparoscopy. Endometrial implants may be excised or obliterated by laser. If the disease is extensive and anatomy is distorted, laparotomy (opening of the abdominal wall via a larger incision) may be required.
While surgical treatments can be very effective in the reduction of pain, the recurrence rate of endometriosis following surgical treatment has been estimated to be as high as 40%. Many doctors recommend for women who have had surgery for endometriosis to take oral medications after surgery to help maintain symptom relief.

Treatment of infertility associated with endometriosis

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Endometriosis is more common in infertile, compared to fertile, women. However, the condition usually does not fully prevent conception. Most women with endometriosis will still be able to conceive, especially those with mild to moderate endometriosis. It is estimated that up to 70% of women with mild and moderate endometriosis will conceive within three years without any specific treatment.
The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo. Infertility associated with endometriosis is more common in women with severe forms of the disease.
Treatment options for infertility associated with endometriosis are varied, but most doctors believe that surgical treatments are superior to hormonal or medical treatments for endometriosis when the goal is enhancement of fertility. Assisted reproduction techniques may also be used when appropriate in combination with surgical therapy.