March is endometriosis awareness month, and one of the main issues that women are promoting is early detection and diagnosis of endometriosis. Because endometriosis can only be diagnosed through laparoscopic surgery, many women live with significant pain and dysfunction for years without being diagnosed or treated.
The good news is that the same procedure to diagnose endometriosis can also be used to treat it. During laparoscopic surgery, the physician inserts a tube in or near the belly button, then pumps carbon dioxide into the pelvic cavity. As the gas expands, it creates a space between all of the pelvic organs. The surgeon then inserts a tiny camera to observe and film any mechanical anomalies, such as endometriosis. If she finds endometriosis, she may burn it with a laser. If she finds adhesions (which are commonly found with endometriosis), she will also burn the adhesions.
A significant amount of women find pain relief after the procedure. However, some women continue to experience pain. In our clinical experience, we have found that many women who still experience pain after laparoscopic surgery have a significant amount of adhesions. (For more information about adhesions and endometriosis, please see our post An Option for Women who are Still Infertile after Laparoscopic Surgery for Endometriosis.)
Some doctors also note that pain recurs because endometriosis has re-grown. In a study published by the Journal of Minimally Invasive Gynecology (2005), researches retrospectively evaluated 115 women who underwent laparoscopic surgery for deep endometriosis. Deep endometriosis can be defined as “rectovaginal lesions as well as infiltrative forms that involve vital structures such as bowel, ureters, and bladder” (Journal of minimally Invasive Gynecology). The researchers evaluated these women to find predictors of deep endometriosis recurrence after surgery.
Of the 115 women, 28 experienced pain recurrence and 15 patients presented with recurrent clinical findings of deep endometriosis. From this group, the researchers were able to determine that the following predicted recurrence:
- Age: Younger patients had a greater risk of recurrence
- Obliteration of the pouch of Douglas: The pouch of Douglas is the space between the rectum and back wall of the uterus. When this cavity is closed during surgery, patients experience a higher risk of recurrence.
- Surgical Completeness: The study found that surgical incompleteness was the only predictor of a necessary second operation for deep endometriosis
If you are considering undergoing laparoscopic surgery for endometriosis, you may ask your doctor about the procedure and how she will minimize the risk of recurrence. If you have already undergone laparoscopic surgery, you may obtain a copy of the surgical report or speak with your doctor to determine if you had any significant risks for recurrence.
To learn more about pain or dysfunction after laparoscopic surgery, see endometriosis pain.