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Endometriosis: Surgeries
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Currently, the only accurate way of diagnosing endometriosis is at the time of surgery (either by open standard laparotomy or laparoscopy). Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia or in some cases local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis.
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Postmenopausal endometriosis may be encountered in women who are on estrogen replacement therapy (ERT). Occasionally, if ERT is administered after total abdominal hysterectomy, endometriosis can be stimulated in an ovarian remnant. Extrapelvic endometriosis is believed to be hormone-resistant when it occurs after surgical castration.20 Transplantation of endometrial implants during the original surgery is believed to explain this occurrence. Another possible explanation is coelomic metaplasia.
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At times, the diagnosis of endometriosis is made during a laparotomy, abdominal surgery which is performed under either general or regional (such as epidural) anesthesia. The incision in the abdomen ranges from approximately two to five inches in length. This abdominal surgery may be needed when a large endometrioma has been identified by the sonogram or if a pelvic mass of uncertain cause is found on examination. In addition, endometriosis may be incidentally found during an abdominal surgery performed for another reason, such as fibroids, an ovarian cyst or even surgery for appendicitis.
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The best way to determine if endometriosis (or any other condition) is present is to visit your gynecologist for a complete physical and pelvic examination. Your physician will conduct diagnostic tests to rule out other conditions. The only way to diagnose endometriosis is through a laparoscopy, which allows the physician to determine if there are endometrial growths by using a laparoscope (tube with lens and light). Today, laser surgery is becoming a more common method for removing these growths in mild to moderate cases.
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The diagnosis of endometriosis can only be confirmed by looking at the pelvic organs at the time of surgery. Areas with the characteristic appearance of endometriosis can then be seen. Usually a minor surgical procedure, called laparoscopy, is performed under general anesthesia for this purpose. A small lighted instrument is inserted through the navel, and the surgeon looks through the instrument directly or, with the aid of a camera attached to the laparoscope, the pelvis can be projected on a TV screen.
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In severe cases of endometriosis, a total hysterectomy and the removal of both ovaries may be the best treatment. Hysterectomy alone is ... effective, but removing the ovaries ensures that endometriosis will not return. Either type of surgery is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy.
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