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Surgical treatments of endometriosis: learning about conservative laparotomy SURGICAL TREATMENTS OF ENDOMETRIOSIS: LEARNING ABOUT CONSERVATIVE LAPAROTOMY
A conservative laparotomy for endometriosis is surgery which attempts to remove or destroy as much endometriosis and as many adhesions as possible while still retaining the uterus and at least one ovary and fallopian tube so that conception and pregnancy are possible. It will also try to correct any other problems of the reproductive organs if they are present.
Who is suitable for a conservative laparotomy?
The reasons for having a conservative laparotomy vary widely and they may include any of the following:
• moderate or severe disease
• endometriomas or cysts greater than two centimeters in diameter
• adhesions, especially if they are causing pain or distortion of the reproductive organs
• involvement of other organs such as the bowel or bladder
• moderate or severe symptoms that have not responded to other treatments
• inability or unwillingness to take hormonal treatment
• desire to conceive immediately
• desire to avoid hysterectomy
• woman's preference
• gynaecologist's preference.
A conservative laparotomy is often the most appropriate form of treatment for more severe forms of endometriosis, particularly if large cysts or adhesions are present. Some gynaecologists believe that a conservative laparotomy is of little benefit for those with minimal or mild endometriosis and that in those cases it should only be used as a last resort if hormonal treatment or laparoscopic surgery is unsuccessful.
Hormonal treatment has little or no effect on adhesions or large cysts and endometriomas greater than two centimeters in diameter as they are made up largely of scar tissue. Surgery is the only way to remove or destroy any adhesions or large cysts and endometriomas.
If your endometriosis involves nearby organs such as the bowel or bladder, surgery may be necessary to ensure the normal functioning of those organs.
Things to discuss before conservative laparotomy
Before your operation it is important that you discuss with your gynaecologist what is intended to be done during the operation. Also ask any other questions or voice any concerns that you may have. In particular, you should make sure that you both agree on the purpose of the surgery and you should discuss what procedures are proposed and you should make it clear if there are any procedures that you particularly do or do not want carried out. You also need to remember that, because each case of endometriosis is unique, until your gynaecologist actually starts the surgery it is difficult to be certain what procedures will be needed.
If your symptoms are manageable and if you are contemplating becoming pregnant soon it may also be worthwhile discussing the timing of your surgery with your gynaecologist. Most infertile women with endometriosis who conceive following a conservative laparotomy do so in the first 12 months after their surgery and you are more likely to conceive after the first bout of surgery than subsequent surgeries. Some gynaecologists believe that, if possible, a conservative laparotomy should be timed for when the woman wishes to become pregnant.
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Hormonal treatment of endometriosis: the oral contraceptive pill