The most common location is the pelvic peritoneum and the organs within it, i.e. the ovaries, fallopian tubes, bowel, ureters, bladder. It is much less common outside the pelvis, for example in the lungs, on the retina or in the brain. To date, scientists have not put forward any unequivocally confirmed theory of the formation of endometriosis. According to one of the most popular, endometrial cells move with menstrual blood through the fallopian tubes into the peritoneal cavity and, during the menstrual cycle, under the influence of hormones undergo the same transformations as endometrial cells found in the uterine cavity. Unfortunately, this theory does not explain cases of endometriosis in organs distant from the pelvis.

The disease is very difficult to treat due to its recurrent nature. "When choosing a patient's treatment path, a number of different aspects need to be taken into account, from the severity of the disease, to her plans for motherhood, to her attitude towards the chosen method. Not every woman accepts surgical intervention. In many cases, dietary treatment, physiotherapy and psychological support turn out to be crucial." - comments Dr Joanna Jacko, gynaecologist at Medicover Hospital.

When to have surgery?

The aim of surgical treatment of endometriosis is to release adhesions, restore anatomical conditions, excise endometrial tumours, improve fertility and, above all, relieve pain. Therefore, this method of treatment should primarily concern women with pain, in whom other treatment methods do not improve. Also, patients with infertility after a thorough diagnosis, ruling out other causes of inability to get pregnant' should consider surgical treatment. "Large endometrial tumours infiltrating the bowel, urinary tract and bladder, as well as the rectovaginal septum are always an indication for surgery," explains Dr Joanna Jacko.

photo: Medicover Hospital

Preparation for surgery

When the decision is made that surgery is necessary, the extent of the operation should be carefully planned. It is very important to accurately assess the progression of the disease and adequately prepare the patient for surgery. If the woman is not on hormonal treatment, the optimal time to perform the operation is the first half of the cycle. Before the operation, imaging studies should be performed, i.e. expert Medical US with contrast, and in selected cases MRI or colonography . The anaesthetist qualifying the patient for anaesthesia will recommend laboratory tests from blood, ECG and X-ray of the chest. Depending on the presence of concomitant chronic diseases, he/she may extend the diagnosis with other tests and specialist consultations. You should report to the hospital the day before the planned operation in order to be adequately prepared for the procedure and to take anticoagulant prophylaxis The patient should be fasting on the day of the operation, which means that 6 -8 hours must have passed since the last meal.

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Why laparoscopy?

When it comes to surgical treatment, laparoscopy is the method of choice. It is a very precise method, allowing us to accurately locate and remove the smallest lesions with the possibility of saving innervation. "During the operation, we view the entire abdominal cavity and the minor pelvis. Using the camera, in close-up, we can see the lesions located in the most inaccessible areas. The better the optical technology, the possibility of 3D imaging and the use of 4K resolution, the better the chances of optimally operating on the patient. At Medicover Hospital, we use modern surgical instruments such as Bisect or monopolar needles. Some of the lesions are removed using argon plasma, because in the case of patients with infertility, this allows us to spare the ovarian reserve," - Dr Joanna Jacko explains.

photo: Medicover Hospital

Recuperation

The return to full strength depends largely on the extent of the operation, as well as the patient's general condition. The more organs affected by the disease, the more lesions need to be excised and the longer the surgery. Fortunately, the majority of patients are young - and if we exclude endometriosis - healthy women. Patients are discharged home after surgery after two to six days. Afterwards, a sparing lifestyle is usually recommended for 4 weeks and after this period a follow-up visit to the doctor who will guide further treatment.

Unfortunately, endometriosis is an unpredictable disease. It can happen that, despite a correctly performed operation, the symptoms return after a few years, but a thorough implementation of the first operation significantly reduces the risk of recurrence. Much depends on the implementation of correct postoperative management aimed at "quieting" the disease. Here, one should think first and foremost about pharmacological treatment, diet and physiotherapy. If the surgical treatment is carried out for infertility, the best chance of getting pregnant is immediately after the operation. Sometimes, during the operation, it turns out that anatomical conditions make it impossible to get pregnant naturally. In such cases, in vitro fertilisation should be used as soon as possible after the operation.

For more information, visit endometriosis.medicover.pl