Based on the severity of the symptoms of endometriosis and the preference of the patient, the doctor will suggest the appropriate type of treatment.
Surgical Procedures for Endometriosis Performed at Marina del Rey Hospital
When medicines and other conservative treatments do not yield a good result, minimally-invasive surgery is considered, especially if the patient wants to conceive a child or if there is severe pain. The main intention of minimally-invasive surgery is to remove or destroy endometrial growth without damaging the reproductive organs. Laparoscopic surgery is more widely considered since it improves the chances of pregnancy and reduces pain. In this procedure, one or two small incisions are made in the abdomen, which allows the introduction of instruments required to destroy or remove endometrial tissues. At the end of the operation, the small cuts are closed using a stitch, surgical tape or glue. The stitches either dissolve or can be removed after a few days. Patients who undergo laparoscopic surgery often have a quick and less painful recovery.
Surgical approaches for the treatment of endometriosis include:
Laser ablation or excision: The laser surgery is a very precise technique, which is capable of accessing difficult areas, and produces less damage to the surrounding tissues. The laser seals off the blood vessels and thus minimizes the bleeding.
Electrocoagulation or diathermy: Electrical heat is used to destroy and remove endometriosis, and as well control bleeding.
Excision Surgery: This technique involves cutting out endometriosis with the help of sharp objects or lasers.
CUSA (Cavitron Ultrasonic Surgical Aspirator): This is a device with an ultrasonic vibration tip, which destroys endometriosis tissue and the aspirator attached next to it sucks the tissue debris.
Helica Thermal Coagulator: Using a process called fulguration, helium gas and a small electric current is used to dry out endometriosis.
Surgical procedures performed using the above techniques are:
Conservative Surgery: This type of surgery is considered if the symptoms are severe, and if the patient wants to avoid any damage to the reproductive organs such as uterus or ovaries so that fertility remains unaffected. Laparoscopic surgery also known as keyhole surgery is used more often. With a procedure called excision, the surgeon will cut and remove endometriosis. Another method used to destroy endometriosis is the application of heat or a laser beam.
Complex Surgery: If the symptoms of endometriosis are severe, surgical procedures involving other organs such as bowel, urinary bladder, cervix and vagina are considered. This is more complex compared to other types of surgery. This procedure is usually carried out using the laparoscopic technique.
Radical Surgery: If the patient does not respond well to drugs or minimally-invasive surgery, and does not want to bear children in the future, radical surgery can be considered.
Types of Radical surgery:
Hysterectomy: In this method, the entire uterus or a part of the uterus is removed, and this surgical procedure is performed under general anesthesia. This procedure can be done with or without the removal of the ovaries. This procedure is irreversible and the patients who undergo hysterectomy will never be able to bear children.
Types of hysterectomy are:
- Partial hysterectomy: In this procedure, a part of the uterus is removed.
- Total hysterectomy: Complete uterus, cervix, and sometimes ovaries and fallopian tubes are removed.
- Radical hysterectomy: In this procedure, the uterus, the tissue on the cervix' sides, and the upper portion of the vagina are all removed.
Oopherectomy: This procedure involves the removal of the ovaries.
- Bilateral oophorectomy: In this procedure, both ovaries will be removed.
- Unilateral oophorectomy: In this procedure, only one ovary is removed leading to irreversible menopause.
Other surgical procedures to treat endometriosis associated with ovaries (endometrioma) are:
Puncturing the cyst: In this procedure, the cyst is punctured in order to drain the fluid out.
Ablation: In this surgical approach, after a puncture is made to the cyst, the fluid is drained, and its base is removed with laser or electrosurgery. Care is taken to make sure that the ovary is not damaged.
Removal of cyst wall: In this procedure, a small portion of the cyst wall is removed; the possibility of recurrence of endometriosis is very less. This procedure can damage the outer layer of the ovary that contains the eggs.
Drugs and Other Treatment Needed for Endometriosis
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain and menstrual cramps. Interruption of the production of the normal cyclical hormone by the ovaries helps in the treatment of endometriosis. These medications change the hormonal levels in the body. These are usually given orally, as injections or through an intra-uterine device.
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