Surgery for Endometriosis Treatment
Your doctor may recommend surgery for endometriosis treatment if other methods, such as pain medicines or hormone therapy, are not reducing symptoms like pain or infertility. Surgery can be risky and lead to life-altering side effects. This is why it is not the first line of treatment used for endometriosis. However, it is important to note that there is no cure for endometriosis at this time.
Even after surgery, endometriosis-related symptoms and pain may return. And, fertility improvements made as a result of surgery may eventually decline again. Research shows that about 20 percent of people who have conservative endometriosis surgery experience symptoms again within 2 years. Around 40 percent or more may experience a return of symptoms within 5 years after surgery. Some experts suggest using hormone therapy along with surgery or after surgery to potentially decrease the chances of symptoms coming back. Some common surgical procedures for endometriosis are outlined below.1,2
Figure 1. Laparoscopic surgery procedure
Laparoscopic surgery is a minimally invasive procedure that is used to diagnose endometriosis. It is also used to remove endometriosis lesions or scar tissue. It is sometimes called conservative surgery. Laparoscopic surgery is also used to address ovarian cysts. This procedure is called a cystectomy. Some people experience pain relief or fertility improvements after lesions or scar tissue are removed.3
If your surgeon finds endometriosis lesions or scar tissue (adhesions) that need to be addressed, they will try to remove or destroy them. In some cases, these lesions may be able to be removed. This process is called an excision. During an excision, a lesion or scar tissue will be cut and removed from the body.3-5
In some cases, a lesion or scar tissue may be removed using extreme heat or energy. When high heat is used, this is called ablation or coagulation. Lesions can also be melted away and destroyed using lasers (vaporization) or electrical current (fulguration).3-5
Your surgeon will tell you what procedure they plan to use during your laparoscopic surgery and how it may impact your recovery. When addressing a cyst (cystectomy), the mass may be cut out, partially removed, or drained.3-5
Figure 2. Laparotic surgery procedure
During a laparotomy, a large incision is made in the abdomen so your doctor can view and address issues within the abdomen and pelvis. Laparotomies are no longer common. Instead, most doctors now opt for laparoscopic surgery, if possible. However, not all people are able to have laparoscopic surgery depending on their endometriosis and personal medical history. If your doctor suggests surgery but you are unable to have a minimally invasive laparoscopic procedure, they may suggest a laparotomy instead.
Once your surgeon makes the incision, they will be able to view the inside of your abdomen and pelvis. From there, they may remove endometrial-related cysts, called endometriomas, from the ovaries. They will remove as much endometriosis as possible to hopefully relieve pain and other endometriosis-related symptoms. Bands of tissue (adhesions) within the pelvis may also be removed to help improve fertility.6-8
There are more risks associated with a laparotomy than laparoscopic surgery. This is because a larger incision is made and the procedure has a longer recovery time.6-8
A hysterectomy is a surgical procedure that involves removing the uterus. Hysterectomies may be used to treat a variety of conditions, including uterine fibroids. Some people with endometriosis receive a hysterectomy after all other efforts to control pain and endometriosis-related symptoms have failed to provide relief. However, it is important to note that there is no cure for endometriosis at this time. Not even a complete hysterectomy can guarantee the condition will never return.
It is possible that not all endometriosis lesions will be removed during the procedure. It is also possible for new lesions to grow in different areas after the procedure. It has been estimated that pain returns in as many as 15 percent of people who undergo radical hysterectomy. This is where the uterus, cervix, ovaries, and other surrounding structures are removed. This rate increases as more structures are left in the body, such as the ovaries.
A hysterectomy directly leads to infertility. This is why it is often a last line of defense against endometriosis pain and symptoms, especially in younger people who may want to have children in the future. The removal of the uterus and the ovaries may also lead to life-impacting side effects that need to be regularly managed long after the surgery.9-11
LUNA and PSN
Doctors may also use 2 procedures to relieve pain by destroying nerve fibers in the pelvis. These procedures are called laparoscopic uterine nerve ablation (LUNA) and presacral neurectomy (PSN). The major difference between these procedures is in which nerves they are targeting. Doctors believe that destroying certain nerve fibers in the pelvis may change how a person perceives pain. In turn, this may reduce overall levels of pain in the pelvis.12
More research is needed to determine the long-term efficacy of these procedures. However, early studies have suggested that PSN may be more effective at reducing pain long-term than LUNA. If you are interested in LUNA or PSN, talk to your doctor to find out if they may be right for you.12