Conservative Surgery:

The goal of conservative surgery is to aggressively remove as many endometrial implants and cysts as possible without causing surgical scarring and subsequent adhesions that could cause fertility problems. Surgery has been shown to improve infertility rates in women with severe endometriosis. Whether it offers any advantage in pregnancy rates in women with mild-to-moderate endometriosis is unclear. Conservative surgery can also help relieve pain caused by implants. It may, however, miss microscopic implants that could continue to cause pain and other symptoms after the procedure.

The two conservative surgical procedures are

• Laparascopy is currently the gold standard and most commonly performed surgical treatment for endometriosis. It involves several small abdominal incisions through which a thin telescopic tube (laparoscope) is inserted. The doctor removes implants and scar tissue and destroys them with heat. Laparoscopy requires general anesthesia, but it is an outpatient procedure and the patient can go home the same day. Recovery usually takes a few weeks.
• Laparotomy uses a wide abdominal incision and conventional surgical instruments. It is much more invasive and requires a longer recovery time (typically several months). Laparotomy is rarely performed except in cases of severe endometriosis.

Laparoscopy Procedure

A laparoscopy is performed as follows:

• Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away so that the doctor has a wider view.
• The procedure requires making small incisions at the navel and above the pubic bone.
• The laparoscope (a narrow tube equipped with camera lenses and a fiber optic light source) is inserted through the incision at the navel (the umbilical incision).
• A probe is then inserted through the second incision, allowing the doctor to directly view the outside surface of the uterus, fallopian tubes, and ovaries.
• One or two additional small incisions can be made on either side of the lower abdomen through these incisions. Surgical instruments or other devices are passed through these accessory incisions to destroy or remove abnormal tissue. Implants can be removed by excision (surgical removal) using a laser or scissors or by destroying the area with lasers or with electricity (or electrocautery).

Complications. Patients may experience temporary but severe discomfort in the shoulders after laparoscopy due to residual carbon dioxide gas that puts pressure on the diaphragm. The incisions, even with laparoscopy, may cause pain afterward, which can usually be treated effectively with mild pain relievers. There are small risks for bleeding, infection, and reaction to anesthesia.

Recurrence. Even with very successful surgery, endometriosis may recur within several months to several years.