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Contents 10
What Is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, particularly on the pelvic organs. Where this tissue grows outside the uterus — especially on the ovaries, fallopian tubes, the inner surfaces of the pelvis, and connective tissues — it can cause inflammation, scar tissue, and adhesions. Endometriosis often causes serious symptoms such as severe pain and infertility, and can negatively affect a woman's quality of life.
The exact cause of endometriosis is unknown, although genetic predisposition, immune system disorders, and environmental factors are thought to play a role. Endometriosis can appear at any age, but it is most often diagnosed in women of reproductive age.
The Purpose of Endometriosis Surgery
The main goal of endometriosis surgery is to remove endometriosis implants, release adhesions, relieve pain, and preserve reproductive function. Surgical intervention is preferred especially for patients who do not respond to medication or who have severe symptoms.
Indications for Endometriosis Surgery
Endometriosis surgery may be performed in the following situations:
Severe Pelvic Pain: Surgery may be preferred in cases of chronic pelvic pain that does not respond to medication.
Infertility: In cases of infertility related to endometriosis, surgical intervention can increase the chance of pregnancy by preserving tubal and ovarian function.
Endometriomas: Endometriosis cysts that form on the ovaries (endometriomas) can cause significant pain or a decline in ovarian function.
Pelvic Masses: Endometriosis can lead to the formation of masses or nodules on the pelvic organs. Surgical intervention is required in these cases.
Bowel or Bladder Involvement: Surgical treatment may be required when endometriosis affects other organs such as the bowel or bladder.
Types of Endometriosis Surgery:
Laparoscopic Surgery:
Definition: The most commonly used minimally invasive method in endometriosis surgery. Laparoscopic surgery involves removing endometriosis implants through small incisions made in the abdomen using a thin camera called a laparoscope and surgical instruments.
Advantages: Being a minimally invasive method, it offers a shorter recovery time, less pain, and a lower risk of infection. Laparoscopic surgery also allows endometriosis implants to be seen in detail and removed precisely.
Procedure: The surgeon makes several small incisions in the abdomen and inserts the laparoscope through one of them. Surgical instruments are inserted through the other incisions to remove or cauterize the endometriosis implants. Adhesions are released at the same time.
Laparotomy (Open Surgery):
Definition: Laparotomy is a surgical method used for larger and more complex cases of endometriosis. In this method, a larger incision is made in the abdomen, and the surgeon removes the endometriosis implants directly through an open surgical field.
Advantages: It provides a wide surgical field, which is why it is preferred especially for severe and widespread cases of endometriosis.
Disadvantages: It involves a longer recovery time, more pain, and a higher risk of infection.
Robotic Surgery:
Definition: Robotic surgery is an extension of laparoscopic surgery, allowing the surgeon to perform precise surgical interventions using robotic arms.
Advantages: It provides more precise surgical interventions, less blood loss, and a shorter recovery time.
Disadvantages: It is a costly method and is not available at every center.
Conservative Surgery:
Definition: Surgical procedures aimed at preserving the reproductive organs. This is performed especially in women planning to have children, with the goal of removing endometriosis implants and releasing adhesions.
Advantages: The reproductive organs are preserved, which increases the chance of future pregnancy.
Disadvantages: There is a risk of recurrent endometriosis.
Radical Surgery (Hysterectomy)
Definition: In severe cases of endometriosis, particularly those that do not respond to other treatments, radical surgical options involving removal of the uterus (hysterectomy), ovaries, and fallopian tubes are considered.
Advantages: This allows endometriosis to be completely eliminated and symptoms to be significantly relieved.
Disadvantages: The chance of pregnancy is completely lost, and hormonal imbalances may occur.
Preparation Before Endometriosis Surgery
A detailed evaluation of the patient must be carried out before endometriosis surgery. This evaluation focuses on the patient's medical history, the severity and extent of symptoms, reproductive plans, and suitability for surgery. In addition, certain tests and imaging methods (such as ultrasound or MRI) may be performed before surgery.
Recovery Process and Follow-Up After Surgery
The recovery process after surgery varies depending on the type of surgery performed. Patients generally return to daily activities within a few days after laparoscopic surgery, while recovery may take longer after more invasive surgeries such as laparotomy.
Pain Management: Postoperative pain can be controlled with analgesic medications.
Follow-Up: Regular follow-up of patients after surgery is important. Since there is a risk of recurrent endometriosis, patients' symptoms should be monitored and additional treatments planned when necessary.
Pregnancy Planning: Patients who undergo conservative surgery should be informed about their reproductive plans after surgery. The chance of pregnancy may increase shortly after surgery.
Surgical Complications and Risks
As with any surgical intervention, endometriosis surgery carries certain risks and possible complications. These include infection, bleeding, injury to organs (particularly neighboring organs such as the bowel, bladder, and ureter), adhesions, and postoperative pain.
Risk of Recurrence: There is a risk that the disease may recur after endometriosis surgery. For this reason, additional treatment methods such as hormone therapy may be considered after surgery.
Endometriosis surgery offers an effective treatment option for women with severe symptoms who have not benefited from other treatment methods. The surgical method is chosen based on the patient's condition, the severity of symptoms, and reproductive plans. Regular follow-up and additional treatment methods after surgery can help reduce the risk of disease recurrence. Endometriosis surgery plays an important role in managing this complex disease and can significantly improve patients' quality of life.