Endometriosis Surgery

Introduction

Endometriosis is a lifelong gynecological disorder where tissue resembling the inner lining of the uterus (endometrium) grows outside the uterus. All of this has the potential to result in intractable pain, heavy bleeding, infertility and other issues. Doctors often recommend endometriosis surgery for women whose symptoms do not respond to medication or lifestyle changes. They use the operation procedure to excise the endometrial lesion, ameliorate the pain, and improve conception.

Since laparoscopic minimally invasive surgeries (including laparoscopic surgery and robotic-assisted surgery) became available, endometriosis surgery has transformed into a safe and therapeutic procedure for the majority of women.

What is Endometriosis Surgery?

Endometriosis surgery refers to the process of removal or destruction of endometriosis implants located outside the uterine cavity. This pathology can also occur in the ovaries, fallopian tubes, pelvic peritoneum, or in intraabdominal organs. The primary indications for surgery are analgesic relief, amelioration of fertility, and recurrence of symptoms.

The disease burden and the patient’s choice will inherently dictate the surgical approach, for example, by the need for fertility preservation.

Why is Endometriosis Surgery Needed?

Surgery is typically recommended for women experiencing:

Severe Pelvic Pain: 

• Chronic pain for more than 6 months causing functional limitations with activities of daily living and at least provably insensitive to medication.

Infertility: 

• Endometriosis-related damage to the reproductive organs can hinder conception.

Ovarian Endometriomas (Chocolate Cysts):

• Fixed ovarian tissue tumors such as on ovaries resulting in ovarian dysfunction (cystic lesions) can produce cysts.

Bowel or Bladder Issues: 

• Endometrial tissue hypertrophy into the bowel or bladder accompanied by pain, bloating and urinary obstruction.

Suspected Advanced Endometriosis: 

• Examples of imaging exhibiting either neoplastic growth of mass or growth of the whole organism.

Types of Endometriosis Surgery

Laparoscopy:

• A minimally invasive procedure with a vision guiding system(e.g., camera).
• Doctors ablate/excise the endometrial lesion using a laser or surgical tools.
• Preferred for mild to moderate cases.

Laparotomy: 

• Open surgery which requires a larger incision in the abdomen.
• It has also been applied in delicate and/or highly complex scenarios when substantial tissue removal is required.

Hysterectomy:

• Incision of the uterus, and rarely fallopian tubes and ovaries.
• Approved in women with heavy endometriosis and no desire to have a baby.

Robotic-Assisted Surgery: 

• An accurate method provides enhanced visualization and better removal of endometrial tissue.

Procedure Steps

Pre-Surgery Evaluation:

• Pelvic Exams: Assess pain and locate endometrial growths.
• Imaging Tests: Ultrasound or MRI for the definition of the volume of pathology. 
• Blood Tests: Evaluate overall health and readiness for surgery.

Anesthesia:

• General anesthesia is achieved to maintain patient comfort during surgery.

Surgical Process:

• Laparoscopy:

• Small incisions are made in the abdomen.
• A laparoscope (camera) is inserted to locate endometrial growths.
• Advancements are destroyed or ripped away with lasers, scalpels or heat.

• Laparotomy:

• There is a deeper incision to access deep growths.

• Hysterectomy:

• It is in the most extreme cases that the uterus and, often, ovaries and fallopian tubes are excised.

Closing the Incisions: 

• Incisions are sealed with suture or adhesive surgical glue and the dressing is peeled off.

Post-Surgery Care:

• Postoperative pain, hemorrhage and other complaints are monitored in patients.

Benefits of Endometriosis Surgery

• Pain Relief: Alleviates chronic pelvic pain and discomfort.
• Improved Fertility: Restores reproductive organ function for better chances of conception.
• Enhanced Quality of Life: Eliminates debilitating symptoms that interfere with daily activities.
• Prevention of Complications: Removal (canalization) of the endometrial tissue (to follow) via ablation as a way to avoid detriment to organs.
• Minimally Invasive Options: Laparoscopy offers faster recovery and minimal scarring.

Cost of Endometriosis Surgery 

• United States: $8,000 – $20,000 
• United Kingdom: $6,000 – $15,000 
• Thailand: $3,500 – $8,000 
• India: $2,500 – $6,000 

Best Hospitals in India for Endometriosis Surgery

India supplies some of the best-specialized hospitals offering treatment of gynecological diseases, including:

Metro Hospital Faridabad: 

• Renowned for advanced laparoscopic and robotic-assisted surgeries.
• Provides comprehensive care for endometriosis-related complications.

Fortis Healthcare (Delhi): 

• Offers state-of-the-art infrastructure and experienced gynecologists.
• Specializes in fertility-preserving surgeries.

Max Healthcare (Delhi): 

• Known for personalized treatment plans and advanced surgical techniques.
• High success rates in managing complex endometriosis cases.

Risks and Complications

While endometriosis surgery is effective, potential risks include:

• Infection: Rare but preventable with proper postoperative care.
• Bleeding: Minor bleeding during or after surgery.
• Scar Tissue Formation: Adhesions may develop, requiring additional treatment.
• Damage to Organs: Rare complications involving the bladder, bowel, or surrounding structures.
• Recurrence: Endometriosis can occasionally recur, more so in the case when the ovaries are not removed.

Recovery

Immediate Recovery:

• Hospital Stay: 1-2 days and as long as 5 days (depending on the type of surgery) for laparoscopy surgery, respectively.
• First Week: Patients may experience mild pain, bloating, and fatigue. Pain medications and rest are essential.

Long-Term Recovery:

• 2-4 Weeks: Patients generally recover with light activities and can continue working, particularly after laparoscopic surgery.
• 6-8 Weeks: Complete postoperative rehabilitation in open surgery; patients no longer lose to physical labor.
• Follow-Up Care: Regular check-ups ensure proper healing and monitor for recurrence.