Laparoscopic surgery
Laparoscopic surgery to remove endometrial implants from pelvic structures and the peritoneal cavity may be the only treatment that effectively mitigates symptoms in women who have severe,disabling endometriosis. Therapeutic laparoscopy for endometriosis can provide long-term relief.However, it does not remove distant endometrial implants, which often continue to produce symptoms. As well, endometrial implants will regrow if a few endometrial cells remain.
Laparotomy Surgery
A laparotomy is the name given to an open abdominal surgery that involves a large (10–15 cm) cut in the abdomen , rather than the small cuts of a laparoscopy. laparotomy used to treat women with severe endometriosis who cannot be treated with a laparoscopy ,laparotomy is required to tackle extensive adhesions especially involving the bowel, bladder and ureter. And also used to examine the organs and tissues of the abdomen when a diagnosis has not been made when the source of an abdominal problem is not obvious
An oophorectomy is when they take out your ovaries and should only be considered once it is clear that the ovaries are contributing to the pelvic pain. Given the overall health benefits and small risk of disease recurrence while taking HRT. Hormone replacement therapy (HRT) is recommended after bilateral oophorectomy in young women
Laparoscopy Versus Laparotomy
Surgical practice has changed so much in recent years that virtually all surgery for endometriosis is possible laparoscopically and laparotomy is only required for a small minority.The views obtained are Significantly enlarged and with modern instruments for haemostasis, which have minimal heat loss, tissues can be clearly identified, allowing for more precise surgery
Laparotomy involves a large incision in the lower abdomen. It involves a longer recovery, more postoperative pain, a longer hospital stay, and more potential complications than laparoscopy
Patients clearly recover more quickly with smaller incisions. However, there is a place for laparotomy in the treatment of endometriosis, when the surgeon is not sufficiently trained in laparoscopic techniques and particularly where multiple previous surgical procedures have been undertaken. In this case a midline incision will be required to be able to perform all the necessary dissection
Ovarian endometriomas
The surgical treatment is generally recommended for large-scale symptomatic endometrioma and the indication for the surgical intervention depends also on the risk of rupture, infection, ovarian torsion and malignant formation. Laparoscopic surgery is the gold standard for endometrioma, but which is the best modality of conservative surgery remains controversial. Drainage alone of endometriomas is not recommended due to the high rate of recurrence. Two main modalities are used:
• Ablation: Another approach is to drain the cyst and destroye with bipolar coagulation or a CO2 laser vaporization following drainage. This is the most used technique.
This procedure has favorable results and cause less anatomic damage and disruption than cystectomy
• Excision of the cyst wall: This is the procedure of choice to decrease recurrence of disease. Although cystectomy is known to have the lowest recurrence rates, it has also been reported to have a negative impact on ovarian reserve and the responsiveness of the ovaries to hormonal stimulation.
Drainage has been cited as more advantageous than ovarian cyst ablation with respect to dysmenorrhea, dyspareunia, chronic pelvic pain, recurrence of ovarian endometriomas, and the ability to achieve spontaneous pregnancy
Laparoscopic cystectomy for endometriomas has been considered a first-line choice of surgical treatment where this technique is preferable to coagulation or laser vaporization with regard to recurrence of cysts and Symptoms and subsequent spontaneous pregnancy in previously subfertile women
Adhesions
Adhesions surgery is typically considered when adhesions are causing significant symptoms or complications. Common symptoms include abdominal pain, bowel obstruction, infertility (if adhesions affect the reproductive organs), and chronic pelvic pain. Adhesions surgery can be performed through various surgical approaches, including laparotomy (open surgery), laparoscopic (minimally invasive) surgery, or robotic-assisted surgery. The choice of approach depends on the location and extent of the adhesions, as well as the surgeon's expertise.
During the surgery, the surgeon carefully separates and removes the adhesions that are causing the problem. This process involves cutting and dissecting the scar tissue to free up the affected organs or tissues. In cases of bowel obstruction, the surgeon may also repair any damage to the intestines caused by the adhesions.
Adhesions surgery, like any surgical procedure, carries risks, which can include infection, bleeding, injury to surrounding structures, and the possibility of new adhesions forming after the surgery. The extent of the risk depends on factors such as the patient's overall health and the complexity of the surgery.
Surgery for DIE
Surgery for DIE is typically considered when conservative treatments such as pain medication and hormonal therapies have not provided adequate relief from symptoms, and when the endometriosis deeply infiltrates pelvic organs and causes significant pain, fertility issues, or other complications
Surgery for DIE is a complex and specialized procedure that often requires the expertise of a gynecological surgeon with experience in treating endometriosis. Several surgical approaches can be used, including laparoscopic (minimally invasive) surgery and, in some cases, open surgery. The choice of approach depends on the extent and location of the endometriotic lesions
During the surgery, the surgeon aims to remove or excise the endometriotic lesions and restore the affected pelvic structures to their normal anatomy. This may involve removing scar tissue, cysts, or nodules, as well as addressing any adhesions that have formed. In cases where endometriosis has affected the bowel or bladder, surgical resection or repair may be necessary. Fertility-preserving techniques may be employed if the patient desires to have children in the future
Surgery for DIE carries inherent surgical risks, such as infection, bleeding, injury to nearby structures, and the possibility of adhesions or recurrence of endometriosis after surgery. The extent of these risks can vary depending on the complexity of the surgery and the individual patient's health
If there is clinical evidence of DIE, the possibility of ureteric, bladder and bowel involvement should be considered pre-operatively to determine the best management. Surgery needs to be performed as safely as possible and by themost appropriatesur geons becauseit may be necessary to resect part of the bladder or ureter, as well as bowel wall
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