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Surgical treatment consists of surgical removal or ablation of the endometriotic lesions. Depending on the location of the lesions, the advancement of the disease, and above all the skills of the operator’s doctor, the procedure is performed using the laparoscopic method or laparotomy.
Laparoscopy is currently the most commonly used surgical and diagnostic method in the case of endometriosis. The procedure involves the insertion of optical and surgical instruments into the peritoneum through small incisions in the abdominal wall (about 1-2 cm). The procedure is performed under general anesthesia and, as before each operation, it is required to determine the blood group, test the coagulation system, biochemistry, electrolyte levels, perform an EKG and chest X-ray.
COURSE OF THE OPERATION
CO gas is injected into the peritoneal cavity prior to laparoscopy2 or air, the pressure of which causes the organs to separate a little, making it easier for the operator to penetrate the interior. Only then are the surgical instruments introduced. In order to exclude a malignant neoplasm, sections of disturbing structures are examined intraoperatively. The doctor removes any endometriosis he has access to.
AFTER THE SURGERY
Movement is indicated on the second day after laparoscopy. Walking reduces the risk of thromboembolism, as well as the formation of postoperative adhesions that form 3 to 5 days after surgery. The great advantage of laparoscopy is the quick wound healing process, thanks to which the patient efficiently recovers and the stay in the hospital is shortened. However, there is always a risk of having to perform a classic surgical procedure consisting in opening the abdominal wall. The decision is made when access to organs is difficult, if only because of numerous adhesions. After laparoscopy, pain is often felt in the area of the arms, collarbones or in the chest, resulting from the injection of gas into the peritoneal cavity. It disappears after a few days, although any alarming worsening should be consulted with a doctor.
Laparoscopy enables the diagnosis and treatment of any abnormalities in the genitals, such as cysts, fibroids, adhesions, and nodules. During it, you can also check the patency of the fallopian tubes. Although laparoscopy is a minimally invasive method, as with any operation, it carries the risk of complications (less than 1%). In extreme cases, the following may occur: pneumothorax (associated with the use of carbon dioxide), gas emboli, damage to large blood vessels, postoperative bleeding, tissue damage caused by devices being introduced into the body), abdominal hernias, anesthetic complications related to the use of general anesthesia.
Laparotomy consists in the classic opening of the abdominal cavity by cutting the skin, subcutaneous tissue, fascia, muscles and the peritoneal membrane. It is mainly used in advanced endometriosis, in the case of massive adhesions or when it is associated with lower operational risk than laparoscopy. The disadvantage of laparotomy is longer convalescence, longer wound healing, greater risk of post-operative infections and the risk of post-operative hernia.
Complications after laparotomy are possible just like after any other surgical procedure. After any minor surgery in the abdomen, adhesions can form. Ask your doctor about the possibility and legitimacy of using an anti-adhesion preparation during surgery!