02 Sep Laparoscopic Surgery for Endometriosis
Do you need a laparoscopy to treat endometriosis?
The recent media spotlight on endometriosis and release of the National Action Plan for Endometriosis by the Australian Government will hopefully lead to a better understanding of endometriosis, its diagnosis and treatment, and ultimately help improve the quality of life for women suffering from this common condition. Laparoscopy has traditionally been the gold standard in diagnosing endometriosis and surgical treatment is often performed at the same time. So, is laparoscopy needed to treat endometriosis?
What is a laparoscopy?
Laparoscopy is a minimally invasive surgical procedure where a slender camera is inserted through the umbilicus to examine the pelvic and abdominal organs. A few other instruments may be inserted through small cuts on abdominal wall to handle organs and treat conditions such as endometriosis.
While some extensive severe endometriosis may be suspected and diagnosed through pelvic ultrasound, laparoscopy is the only way to confirm these findings. It allows examination of pelvic organs, documentation through photographs, biopsies of tissue to confirm presence of endometriosis under microscopic examination and removal of endometriosis when present.
When women see their doctor with painful periods or pelvic pain, endometriosis is often considered a likely cause. Initially, investigations such as ultrasound maybe conducted and medical treatments are frequently started before more invasive procedures such as laparoscopy are performed.
What is endometriosis?
Endometriosis occurs when cells similar to the ones lining the cavity of the uterus are found outside the uterus. It is a common finding in women with up to 10% of women diagnosed with endometriosis.
Endometriosis can lead to painful periods, pelvic pain and reduced fertility. It may also not cause any symptoms and be found incidentally when a laparoscopy is performed for another reason, such as during removal of ovarian cyst or appendix.
The severity of endometriosis does not correlate with its symptoms. There are many women who have severe endometriosis seen on laparoscopy without any symptoms or problem conceiving. There are also many women who suffer severe pain with minimal or no visible endometriosis at laparoscopy.
How is endometriosis treated?
Treatment is dependent on symptoms. Painful periods may be treated with simple pain medications and hormonal medications such as the contraceptive pill.
Laparoscopy helps to detect endometriosis and treat it at the same time if it is present – by removing it and confirming it under microscopy. Removing endometriosis may help relieve pain and painful periods. Hormonal medications may be continued after surgical treatment to reduce the chance of endometriosis recurring. Hormonal treatment is, of course contraindicated if you are trying to conceive. Removal of endometriosis and endometrioma (chocolate cyst) has been shown to improve likelihood of conception.
Pain medications including non steroidal and pain modulators may be helpful. Other measures such as hot packs, gentle exercises, yoga and meditation can be very useful too.
Endometriosis does not need treatment if it is found incidentally and not causing any symptoms.
Who should treat your endometriosis?
Endometriosis and associated pelvic pain should be diagnosed and treated promptly. Too commonly, when left untreated, it can result in chronic pain and lower quality of life. Pelvic pain resulting from endometriosis should be managed using a multidisciplinary approach and involve the patient, empowering them with an understanding of the complex pathways that result in chronic pain and, its long term treatment. Knowledge of what underlies the sensation of pain and feeling in control of situation itself is helpful in managing the pain. Members of the team may include a pain specialist, GP, gynaecologist, physiotherapist, psychologist and dietician.
Gynaecologists help to manage the period with hormonal medications and perform laparoscopy to diagnose and treat endometriosis. If laparoscopy is considered, this should be performed by gynaecologist specializing in minimally invasive laparoscopic surgery with high volume experience. This leads to higher likelihood that the endometriosis is correctly diagnosed and removed entirely. If you are having a laparoscopy, make the one laparoscopy count in order to avoid repeated surgery. Each surgery carries risks and repeated surgery is not a sign of optimal management of endometriosis.