Endometriosis is a fairly common condition, particularly in women over 30 who do not yet have children, in which cells from the endometrium (the lining of the uterus) grow elsewhere in the body, usually around the uterus, the ovaries and the fallopian tubes. Endometriosis affects 1 in 10 women, mainly during their reproductive years, and is one of the leading causes of infertility.
The initial treatment of endometriosis is always surgical, by laparoscopy; hormone treatment may then be added after the operation.
Open surgery (laparotomy) no longer has a place in treating endometriosis where fertility is the concern, since laparoscopy gives an extremely clear view and allows every focus of endometriosis to be identified — and the disease is often multifocal. The surgeon removes all visible endometriotic deposits while taking care to preserve tissues such as the nerve plexuses that are important for bladder and bowel function. It is carried out through four small incisions (5–10 mm) through which fine manoeuvres are performed, and the patient goes home the following day.
The laparoscopic operation is tailored to the stage of the endometriosis. If, for example, the disease is superficial and early-stage, electrocautery of all the deposits is enough; in advanced-stage endometriosis, by contrast, a more extensive laparoscopic procedure is performed, removing all the diseased tissue, effectively restoring the function of the pelvic organs and eliminating the pain completely.
When a couple has unexplained infertility, or the woman has had unsuccessful IVF attempts, laparoscopy should always be performed to rule out endometriosis. Laparoscopic treatment of even very mild endometriosis is essential before a woman goes on to assisted reproduction treatment.
The doctor's advice
Dr. Michael Rotas emphasizes that when laparoscopy for endometriosis is carried out by an experienced, specialist surgeon with a modern, patient-centred approach, the difficulties of diagnosis can readily be overcome — reducing what patients go through, restoring their trust in the medical process and lifting their morale. At the same time it achieves the best possible outcome for the patient's quality of life and fertility, and can significantly shorten her treatment and recovery.