Surgery may be considered for women with severe pain whose symptoms are not relieved with medication. For these women, the treatment can be tailored depending on whether they want to be able to have children. Conservative surgery can help preserve a woman's ability to become pregnant.
Conservative surgery for endometriosis is performed to remove areas of endometriosis and to divide adhesions without removing the uterus or the ovaries. It is offered to women who wish to be able to have children in the future.
One problem with conservative surgery is that it usually provides only a temporary measure of relief, as endometriosis recurs in most women.
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Very often, conservative surgery will be performed after a course of danazol or GnRH agonists, as the results of surgery tend to be better.
When a laparoscopy is done to confirm a diagnosis of endometriosis, the endometrial tissue can be removed at the same time. Laparoscopy is performed by inserting a pencil-thin instrument through an incision in the abdomen (usually in the belly button). It gives the physician an exceptionally clear view, on a television monitor, of the inside of the abdominal cavity.
The physician can pass other instruments through the same incision, or through other tiny incisions, to remove the misplaced endometrial tissue.
In laparotomy, an incision is made in the abdomen and the abdominal cavity is opened and explored for signs of disease. Any endometrial tissue is removed, and the incision is then closed.
Laparotomy is major surgery that requires a brief hospital stay and three to four weeks of recuperation afterwards. This procedure is not performed as commonly as laparoscopy.
A laser is a device that concentrates light into an intense beam to produce heat that can destroy misplaced endometrial tissue. A variety of lasers can been used for treating endometriosis during laparoscopy. Although laser surgery is an important advance, it has not been shown to be superior or safer than other laparoscopic methods that destroy tissue, such as the use of electrical probes or direct heat.
This procedure uses an electrical current to produce heat and destroy the patches of endometrial tissue. As with laser surgery, electrocautery is performed during laparoscopy.