Endometriosis Surgery

Definition

Endometriosis is one of the most common gynaecological conditions, affecting millions of women and girls worldwide. The frequency of endometriosis diagnoses is on the rise. The disease can cause acute pain, infertility, and force the patient to undergo numerous operations. Normal daily life can become impossible. In previous studies, 50% of girls operated for recurring lower abdominal pain were affected by endometriosis. The complete elimination of endometriosis foci is currently the treatment of choice to relieve pain caused by this disease. This applies to endometrioses located on the intestines, on a ureter or in a deep section of the small pelvis. In contrast, hysterectomy is not the generally preferred treatment and only applies to specific clinical situations. Thus, hysterectomy alone that leaves behind endometriosis foci deeply buried in the pelvic cavity will often fail to provide any relief from pain after the operation.

Currently, laparoscopy remains the gold standard in the treatment of endometriosis. Indeed, this method reveals even the smallest foci of tissue formations that would have remained invisible to the naked eye in open surgery. Laparoscopy may even be used to treat endometriosis that has extended to the intestines, to the bladder or to the ureters (possibilities include the removal of a fraction of the vesical wall, the removal of an affected ureter, etc.).

Treatment

Deep rectal-vaginal endometriosis is the variant of the disease that is among the most difficult to treat.

Partial excision of the rectum is not an easy operation, regardless of the chosen open or laparoscopic surgery option. In addition to the technical difficulties inherent to the intervention, the risk of vesical or intestinal dysfunction after the operation must also be considered. Indeed, this type of endometriosis is located in the vicinity of the nerves that control vesical, intestinal and sexual functions. A surgical intervention may thus easily reach these nerves, leading to partial or complete loss of the functions described above. In the worst case scenario, the patient finds it impossible to empty her bladder. If so, the only option for the patient is to use a urinary catheter to empty her bladder five to ten times a day for the rest of her life.

In most cases, however, patients experience an attenuated form of the disease and are still capable of emptying their bladder, albeit incompletely. Vesical capacity increases gradually, which generally leads to bladder distension. As a result, the patient still has to resort to a urinary catheter. Vesical distension is often accompanied by strong urinary intravesical pressure and urine reflux towards the kidneys. There is thus a high risk of developing kidney lesions with severe consequences.

Thanks to laparoscopy (the LANN method), it is nowadays possible to identify and preserve all the important nerves in the small pelvis. As a consequence, the risk of developing a vesical disturbance is reduced to approximately 1%, a much lower incidence compared to the 20 to 40% risk associated with the other techniques.