Endometriosis - Treatment

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• Conservative Surgery (Laparoscopy or Laparotomy). Conservative surgery uses minimally invasive laparoscopy, or sometimes laparotomy (conventional “open” surgery through normal incision), to remove the endometriosis implants without removing any normal tissue or reproductive organs. It is a good option for women who wish to become pregnant or who cannot tolerate hormone therapy. Endometriosis often recurs after conservative surgery, however. The risk for recurrence or residual pain after any procedure increases with the severity of the condition, particularly if endometriosis has affected areas outside the uterus.
• Radical Surgery (Hysterectomy). Hysterectomy offers the best option for either a cure or more significant control of the problem. Younger patients can often have only a hysterectomy while leaving one or both of their ovaries intact. However, if endometriosis has developed outside the uterus then even this procedure is not curative. Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Removing both ovaries (bilateral oophorectomy) along with the uterus is the only potential cure for endometriosis.

Click the icon to see an illustrated series detailing hysterectomy.

In choosing between hysterectomy (with or without removal of the ovaries) and conservative surgeries, age and the desire for children are important factors.

Nerve Surgery for Pelvic Pain. Laparascopic uterine nerve ablation (LUNA) and laparoscopic presacral neurectomy (LPSN) are procedures that aim to reduce chronic pelvic pain by destroying or interrupting the nerves that attach the uterus to the pelvic bone. Some small studies have shown more benefit for LPSN than for LUNA. LPSN appears to work best when combined with laparoscopic ablation of endometrial implants (conservative surgery). Stronger evidence is needed before these procedure scan be recommended for women with chronic pelvic pain associated with endometriosis. Many insurance companies consider these procedures experimental and will not pay for them.