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By In-house Team, Circle Health Group

Endometriosis surgery Q&A

We sit down with a consultant gynaecologist to discuss endometriosis and the different types of surgery available to treat it

Endometriosis affects roughly 10% of women in the UK and can take an average of seven and a half years to diagnose. According to Endometriosis UK, it is the second most common gynaecological condition in the UK, experienced by around 1.5 million women.

If you have endometriosis or know someone grappling with the symptoms of this challenging condition, then you’ll want to know everything you can about surgery to treat it. We’ve got you covered.

Consultant gynaecologist and endometriosis specialist Mr Ahmad Sayasneh  answers some of your most commonly questions about how the condition is treated with surgery.

What is endometriosis?

It helps to know more about endometriosis before learning more about surgery for the condition.

Endometriosis is a chronic medical condition that occurs when tissue similar to the lining of your uterus (the endometrium) grows outside of your uterus.

This tissue can grow on various pelvic organs and tissues, such as your ovaries, fallopian tubes, bowel, and even your bladder. These growths can cause inflammation, pain, and sometimes fertility problems. Some key symptoms of endometriosis are pelvic pain, irregular or heavy bleeding, painful periods, pain during sex, tummy bloating, and even back pain.

The decision to have surgery for endometriosis is different for everyone. Your consultant will discuss your treatment options in detail, including surgery.

When is surgery needed for endometriosis?

Surgery for endometriosis is used when other treatment options such as pain medication, pelvic rehabilitation, and hormonal therapy, have not helped improve your symptoms, or to confirm your diagnosis and understand how badly endometrial tissue has spread across your pelvic organs.

The decision to have surgery for endometriosis is different for everyone. Your consultant will discuss your treatment options in detail, including surgery. They will ensure you get the right treatment for your circumstances – many people have a combination of several treatment options for the best results.

How do you prepare for surgery for endometriosis?

Depending on your age and medical history, your surgeon might order preoperative tests such as blood tests, urine tests, and an electrocardiogram (ECG or EKG), to assess whether you’re fit and health for surgery.

You will likely need to fast before surgery. Your consultant will provide specific instructions about when to stop eating and drinking and how long for. If you smoke, quitting or reducing smoking before surgery can speed up your recovery time and reduce the risk of complications. We also recommend avoiding alcohol in the days leading up to surgery.

You might also be asked to stop taking certain medication before surgery – these are usually blood thinners.

Before coming to hospital, prepare your home for a comfortable recovery. Stock up on groceries, prepare easy-to-prepare meals, and create a comfortable recovery space with essentials like pillows and blankets.

Don't hesitate to ask any questions or voice any concerns you have about the surgery to your consultant. They will be there every step of the way to answer your questions.

How is endometriosis surgery performed?

Most people will have a laparoscopic (keyhole) procedure to treat their endometriosis. This is a minimally invasive approach.

During a laparoscopy, small incisions are made across your tummy so that your consultant can access your abdomen and pelvis without making large, open incisions. A laparoscope is a specialist instrument that has a small light and camera attached to the end of it. The camera is connected to the monitor so your consultant can look inside your stomach to perform the operation with precision.

Laparoscopic surgery for endometriosis is usually performed under general anaesthetic, meaning you won’t be awake throughout the procedure. The benefits of keyhole surgery include a faster recovery time, less pain and bleeding after your operation, and reduced scarring.

What types of surgery are available for endometriosis?

There are two different surgical techniques that can be used to remove areas of endometriosis. These are ablation and excision surgery. Both can be performed during a laparoscopy to remove endometriosis tissue.

Laparoscopic ablation is generally considered less invasive than excision and might be suitable for people with less extensive or superficial endometriosis. The surgery and technique your consultant will use depends on your individual situation as well as their preference.

What is the difference between ablation and excision surgery?

Ablation surgery involves treating endometriosis by burning it with heat or energy, while excision involves removing the endometriosis by cutting it out – both are performed using specialist instruments. As mentioned above, the choice between laparoscopic excision and laparoscopic ablation depends on several factors, including the severity and extent of your endometriosis, your symptoms and fertility goals, and your consultant’s preference.

Often, when endometriotic growths or nodules are removed through surgery, they’ll be sent to the laboratory to confirm your diagnosis under a microscope (if you haven’t already been diagnosed with endometriosis).

This is also true for endometrioma, which are cysts in your ovaries (sometimes called chocolate cysts because they contain old, brown blood).

What is the recovery period like after surgery?

The recovery period after laparoscopic surgery for endometriosis can vary depending on several factors, including your general health and fitness levels, your age, and the severity of your endometriosis.

You can usually return home from hospital on the same day as the surgery, but you’ll need someone to drive you as you might feel a bit drowsy as the anaesthetic wears off. You might experience some pain or discomfort around the area of your incisions after laparoscopic surgery, which is usually managed with pain medication and plenty of rest. Be gentle with yourself while you recover and wear loose fitted, comfortable clothing to minimise discomfort across your pelvic area.

The time it takes to return to work and normal activities can vary depending on the type of surgery you have. Some people might be able to return to desk work within a few days, while others might need a few weeks of recovery getting back to work and everyday activities. Initially, avoid high-impact exercises, such as running or jumping, that could put strain on your abdominal area. Focus on low-impact activities like swimming or yoga in the first couple of weeks after surgery.

Pay close attention to how your body responds to exercise. If you experience pain, discomfort, or fatigue, stop the activity and rest. Do not push yourself too hard during the early stages of recovery. Be cautious with exercises that engage your core muscles, as they might put strain your incisions.

Your consultant will let you know when it’s safe to return to more high-impact activities such intensive cardio and heavy lifting.

According to the NHS, it can take up to 12 weeks to fully recover from a laparoscopic procedure for endometriosis.

Can I get pregnant after having endometriosis surgery?

You should be able to, yes. After a short period of recovery after surgery (up to six weeks), you will have a follow-up assessment and most likely be encouraged to start trying to get pregnant.

If there are no other reasons to stop you getting pregnant (such as a partner’s low sperm count), you’ll normally be advised to try for around six months before considering further fertility help or treatment. After six months you’ll normally be recommended to a tertiary infertility centre, where you’ll perhaps be recommended IUI or IVF.

At this time, you will of course be given other tests, such as ovulation check-ups, ultrasounds and hormone tests, and your partner will have relevant checks too.

While surgery can be very effective in removing endometrial tissue and helping you manage your symptoms, it is not always a permanent cure.

Can endometriosis come back after surgery?

Yes, endometriosis can come back after surgery. While surgery can be very effective in removing endometrial tissue and helping you manage your symptoms, it is not always a permanent cure. The likelihood of recurrence can vary depending on several factors, including the type of surgery you had, the extent and severity of your endometriosis, and your individual response to treatment.

Your consultant will monitor your progress closely at your follow-up appointments to ensure you manage the condition as effectively as possible after surgery.

Get help with Circle Health Group

At Circle Health Group we offer tailored treatment, including laparoscopic surgery for endometriosis, with a network of thousands of consultant gynaecologists. We also have bespoke aftercare programmes to help you recover from surgery as soon as possible, including pelvic rehabilitation.

If you want to know more about our treatment options, book your appointment online today or call a member of our team directly.

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If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.