Endometriosis, a condition where tissue resembling the uterine lining proliferates outside the uterus, is a common health issue that affects about 1 in 10 women of reproductive age. Its manifestations, such as pelvic pain, heavy bleeding, and fertility problems, can significantly impact a person’s quality of life. This comprehensive guide aims to shed light on what is endometriosis excision surgery, a potential treatment intervention for this chronic condition.
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Understanding Endometriosis
Endometriosis is a chronic inflammatory disorder that can cause debilitating symptoms, including severe pelvic pain, excessive menstrual bleeding, and fertility complications. The disease occurs when tissue similar to the endometrium, grows in places it shouldn’t, such as the ovaries, fallopian tubes, lining of the pelvic cavity and even organs such as intestine, bladder, ureters, diaphragm, and many other organs.
Historical Background of Endometriosis Treatment
Before delving into what endometriosis excision surgery entails, it’s crucial to understand its historical context. In the 1800s, surgical treatment for endometriosis involved opening the patient and excising the disease. This method remained the standard until the advent of laparoscopy and lasers in the 1970s and 1980s.
Laparoscopy, a minimally invasive surgical procedure, revolutionized how surgeons operated on deep internal structures. This technique involved making small incisions to allow the insertion of a telescope and surgical instruments. Along with laparoscopy came the development of new surgical tools like lasers and the technique of endometriosis ablation, which involved burning off the disease utilizing either cautery (electricity) or laser (light energy).
Despite the lack of substantial evidence to justify these methods, laparoscopy with ablation of endometriosis became recognized as the standard way to treat the condition by the early 1990s. However, studies conducted to assess pain relief after ablation surgery showed that this technique wasn’t effective, leading to a recurrence of pain in a substantial number of patients.
Emergence of Excision Surgery
Amid the limitations and shortcomings of ablation, a more effective option emerged: excision of endometriosis. This procedure involves cutting out the disease entirely, regardless of its location. Excision surgery allows healthcare providers to remove endometriosis that lies over critical structures like the ureters and bowel, where burning the disease isn’t safe.
The method of excision isn’t as important as the complete removal of all disease. Surgeons can use various tools, including lasers, cautery, or robots, to facilitate excision. This technique has undergone extensive study, with multiple research findings around the world showing consistent results.
Read More: What are the treatment options for Endometriosis?
Laparoscopic Excision Surgery
Laparoscopic excision surgery is a minimally invasive procedure that aims to remove endometrial-like tissue growing outside the uterus and repair any damage caused by endometriosis. It is suitable for moderate to severe cases and can help reduce pelvic pain, back pain, bladder pain, and other symptoms.
During the procedure, the surgeon makes small incisions in the abdomen and inserts a laparoscope, a thin tube equipped with a camera. This allows the surgeon to visualize the pelvic cavity and remove the endometriosis tissue using other surgical instruments.
Comparing Excision Surgery with Ablation
While both excision and ablation are types of laparoscopic surgery for endometriosis, they are not equivalent. Ablation involves destroying the endometriosis tissue by burning, freezing, or electrifying it. On the other hand, excision surgery involves cutting out the endometrial tissue entirely leaving free margins of the disease.
Studies have shown that patients who undergo excision surgery experience significantly greater improvement in symptoms such as pelvic pain, painful periods, and difficulty passing stool compared to those who have ablation surgery with significantly lower rates of recurrence compared to high rates of 40-60% 1-2 years after surgery in patients undergone ablation.
Post-Operative Outcomes and Recurrence
After successful excision surgery, about half of the patients experience no further pain and have no reasons for subsequent surgery. However, recurrence is possible, and around 19% of patients might experience persistent or recurring endometriosis after expert-performed excision surgery.
The Relevance of the Surgeon’s Skill
The surgeon’s skill and experience play a significant role in the success of endometriosis excision surgery. There is a significant difference in the ability to remove all endometriosis between a surgeon who performs 15-25 major endometriosis excision cases a month and those who dabble in it. Therefore, it’s crucial to choose a surgeon who is well-versed in endometriosis excision.
Read More: How new Endometriosis guidelines will improve diagnosis and treatment.
Potential Side Effects of Excision Surgery
Like any other surgical procedure, excision surgery can have potential side effects, including pain and discomfort, infection, bleeding, damage to surrounding organs, scar tissue, and possible infertility.
Recovery and Post-Operative Care
Recovery from excision surgery for severe endometriosis can take up to 4 weeks. It may also take up to 6 months for patients to notice improvements in their endometriosis symptoms, although recovery times may be shorter for moderate cases.
Other Treatment Options
While excision surgery is one of the most effective treatment options for endometriosis, it may not be suitable for everyone. Some patients may require a combination of surgery and pharmacological treatment to manage their endometriosis effectively.
The Bottom Line
Endometriosis excision surgery emerges as a critical and effective intervention for combatting the complexities of endometriosis, a condition affecting a significant portion of women in their reproductive years. This minimally invasive procedure, distinguished by the complete removal of aberrant endometrial-like tissue, offers a promising path for alleviating debilitating symptoms and enhancing quality of life. With its proven lower recurrence rates and potential for long-term relief, it underscores the importance of informed decision-making and selecting skilled surgeons. Excision surgery stands not just as a treatment, but as a beacon of hope for those grappling with this chronic ailment.
References:
https://www.medicalnewstoday.com/articles/endometriosis-excision-surgery
https://my.clevelandclinic.org/health/treatments/4620-endometriosis-surgery
https://www.endofound.org/scheduling-excision-surgery-considerations-to-keep-in-mind