Endometriosis - Conservative Surgery

Hysterectomy

Hysterectomy is the surgical removal of the uterus. Endometriosis accounts for a significant percentage of these procedures. Hysterectomy does not, however, necessarily cure endometriosis.

A woman cannot become pregnant after having a hysterectomy. Women should realize that hysterectomy causes immediate menopause if the ovaries are removed.

[For more information, see In-Depth Report #73: Uterine fibroids and hysterectomy.]

Types of Hysterectomies

Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:

• Total Hysterectomy (Removal of uterus and cervix). Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Subtotal hysterectomy involves removing the uterus but keeping the cervix intact.
• Bilateral Oophorectomy (Removal of both ovaries) or Bilateral Salpingo-Oophorectomy (Removal of the fallopian tubes and ovaries). For endometriosis treatment, removal of the ovaries is often performed in combination with hysterectomy. This is the only potential cure for endometriosis. If endometriosis has developed outside the uterus then even ovary removal procedures are not curative.

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Removal of the ovaries (oophorectomy) along with hysterectomy significantly reduces the likelihood that endometriosis will recur. However, there is still a small chance that recurrence can happen.

Types of Hysterectomy Procedures

Hysterectomies may be performed abdominally (through an incision in the abdomen) or vaginally (through a vaginal incision). A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). There are other laparoscopic approaches as well.

Recovery times for vaginal hysterectomy and LAVH are shorter than those for abdominal hysterectomy. However, hospital stays may be longer with LAVH than standard vaginal hysterectomy. It is not clear whether LAVH adds any significant benefits compared to the standard vaginal procedure. Abdominal hysterectomy is still the most commonly performed procedure.