ENDOMETRIOSIS SURGERY

Endometriosis is an under-diagnosed and under-treated problem. It is estimated that 1 in every 10 women have endometriosis during their reproductive years. However, many women did not realize that they have endometriosis until it causes severe pain or fertility problems. Indeed, multi-country studies show that there is a significant delay of up to 7-12 years in the diagnosis of endometriosis.

Endometriosis can cause:

• Painful periods or chronic pelvic pain that affect normal activities
• Fertility issues – even mild forms of endometriosis can reduce chance of achieving pregnancy with natural conception
• Scarring and adhesions around pelvic structures
• Pain or dysfunction in bowel or urinary tract if these organs are affected

Know more about endometriosis

Why surgery?

A surgery is the gold standard to diagnose endometriosis and the only effective way to remove endometriosis. A surgery would be beneficial to you if:

• You have severe pain that needs a high dose of analgesics in long-term
• Your pain is affecting your quality of life or normal activities despite the use of analgesics
• You have a “chocolate cyst” (endometrioma), which is caused by endometriosis in the ovary
• Your fertility specialist have suggested surgery to increase the chance of natural conception or successful IVF
• You have bowel, bladder or other organ dysfunction that are likely to be caused by severe endometriosis

What are the alternatives to surgery?

Medical treatments may be offered to patients with chronic pain or endometriosis. Although it is reasonable to use these medical treatments as first-line therapies to relieve symptoms, none of them can remove endometriosis. The symptoms and disease will return once the woman stops using the medication. These treatments are usually:

• Simple analgesics - common ones are Panadol, Endone, Napropen, Ibuprofen
• Hormone treatments – e.g. oral contraceptive pill
• Mirena - a special intrauterine device that slowly release a hormone called levonorgestrel

Hormonal treatments or Mirena are not suitable for women who are trying to get pregnant.

How does laparoscopy (keyhole) surgery help?

The most effective way to remove endometriosis is with laparoscopic (keyhole) surgery. The high-definition, magnifying camera in laparoscopy (called laparoscope) allows doctors to have an accurate view of pelvic structures and identify endometriosis. The sophisticated, dedicated laparoscopic devices are also ideal for precise removal of endometriosis around pelvic organs.

Know more about laparoscopic surgery

Endometriosis surgery is a highly specialized procedure. Before going for surgery, it is important to ask your doctor:

• What is their experience in endometriosis surgery? Clinical studies have shown that surgeons’ experience is crucial in avoiding under-diagnosis. Mild forms of endometriosis can be easily overlooked. Research studies have shown that among the women who were told to have a normal pelvis after a laparoscopy, some of them are actually found to have endometriosis disease upon a second look by a specialized endometriosis surgeon. In other words, without the laparoscopy by more experienced surgeons, the true cause of pain and infertility would have remained a mystery.
• What is the next step if endometriosis is present? Removing endometriosis from pelvic structures demands advanced laparoscopic skills from the surgeons, especially when the disease is severe and has deeply infiltrated into the pelvis. Therefore, in Australia, it is not an uncommon practice among gynaecologists to offer a pure “diagnostic laparoscopy”. A diagnostic laparoscopy does not aim at any therapeutic effect – The disease is left behind, and the patient is then advised to use medical treatment for symptomatic relief, or referred to an appropriate surgeon for a second surgery. On the other hand, many specialized endometriosis surgeons adopt a “see-and-treat” approach - Endometriosis that are found on lasparoscopy are removed in the same surgery.

Our “one-go” diagnostic and therapeutic endometriosis surgery
Our surgeon is experienced in diagnosing and treating endometriosis by advanced laparoscopic techniques. We are familiar with all form and severity of endometriosis. Our principle is to remove all disease that causes symptoms, while preserving the normal functions of pelvic organs and fertility.

Our “see-and-treat” strategy means that once endometriosis is identified, the disease is removed in the same surgery. In this way, the optimal therapeutic result can be achieved in one surgery. A second stage surgery is only reserved for the exceptional cases where the disease is very severe or involves structures outside the reproductive organs, e.g. bowel, bladder and urinary tract.

Our doctor will advise you on the options and treatment strategy in specific to your individual condition and personal needs.

What do you expect after surgery?

Compared to an open surgery, patients who have undergone a laparoscopic surgery have less pain and scarring, go home earlier and recover quicker. Full recovery usually takes 2-3 weeks. The recovery time varies according to the extent of the disease and complexity of the surgery.

In the hands of experienced surgeons, women are six times more likely to have reduced pelvic pain six months after their endometriosis surgery.^* For women with fertility problems, they are more likely to fall pregnant after the surgery and have a take home baby.

For patients who are not planning to get pregnant, there are options of adjuvant medical treatment that can reduce the chance of recurrence in the future. Our specialists will discuss this with you.

For women who have had infertility issues, they can try to get pregnant once the recovery period is over, either by natural conception or IVF.

What do I do now?

Every woman is individual and her situation requires a tailored plan of management. If you think these issues relate to you, please contact us to arrange a personal consultation and discussion of your case.

^*Compared to a diagnostic laparoscopy. Laparoscopic surgery for endometriosis (Review). Cochrane Database Syst Rev. 2014 Apr 3;4.