The decision about whether to have surgery for endometriosis is difficult. Surgery can eliminate symptoms of endometriosis, however it can also lead to further pain, constipation, a feeling of having to urinate, and infertility. It is also possible that one surgery will not fix the problem, and additional surgeries will be necessary to find relief.
It is estimated that as many as five million women suffer from endometriosis in the United States alone. Endometriosis occurs when uterine tissue develops outside of the uterus and attaches to other internal organs. The uterine tissue bleeds during the woman's menstrual cycle, but this blood has no way to exit the body. It remains inside, leading to adhesions on the fallopian tubes, bowels, intestines, and other organs. Symptoms of endometriosis include painful periods, pain during or after sex, pelvic pain, backaches, and fertility problems.
There are several different types of surgery for endometriosis. Laparoscopy is a minimum-invasive surgery. The physician makes a small incision below the naval and inserts a light and scalpel or laser. He or she then removes the adhesions that are responsible for endometrial pain. In a laparotomy, the physician makes an incision in the abdomen, making this a more invasive surgery. This surgery provides better access than a laparoscopy procedure, making it easier to see and remove adhesions, although, the large incision increases the likelihood of scar tissue developing after the procedure, which can lead to new adhesions.
Hysterectomies are another surgery for endometriosis. The main drawback of a hysterectomy as surgery for endometriosis is that it eliminates the chance of the woman bearing a child. Some doctors only remove the uterus in endometriosis patients, however, better results are seen if the cervix and ovaries are removed as well. Leaving the ovaries increases the risk of the patient still experiencing pain after surgery, because the ovaries continue to produce estrogen. Leaving the cervix increases the patient's risk of bleeding.
Two surgeries that do not cure endometriosis, but eliminate discomfort associated with the condition are presacral neurectomy and laparoscopic uterosacral nerve ablation. In presacral neurectomy, or PSN, surgery, the doctor severs the presacral nerve, which is the nerve that transmits feeling to the pelvic floor and uterus. While effective at relieving pain, patients may experience urinary urgency or constipation as an unpleasant side effect. There are no sexual side effects. During laparoscopic uterosacral nerve ablation, or LUNA, the physician performs laparoscopy surgery to sever the nerves that provide sensation to the cervix and lower pelvic region.