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Treatments for endometriosis: surgical treatments TREATMENTS FOR ENDOMETRIOSIS: SURGICAL TREATMENTS
Excisional surgery for endometriosis means cutting and removing or destroying endometriosis tissue wherever it lies in the pelvis. The surgery can be performed in a traditional manner through a large, open abdominal incision about 13 cm wide (open excisional surgery at laparotomy) or during a laparoscope in which the inside of the pelvis is viewed through a laparoscope, a tubular instrument with a light at one end and an eyepiece at the other, which is used to 'spotlight' internal organs.
If surgery is to be performed in the latter manner, a woman is anaesthetised for laparoscopy (usually a general anaesthetic) and then several small incisions (up to 1 cm each) are made in her abdominal wall. A needle inserted through one of these incisions is used to introduce carbon dioxide or nitrous oxide gas into the abdomen. The gas separates the organs from each other so that the doctor can gain a clear view. The gas also expands the abdomen, making the woman look about six months pregnant — but only until the end of the procedure when she regains her normal shape. Meanwhile, the laparoscope and any other instruments needed to cut out endometriosis tissue are introduced through the other incisions. For instance, a laser (for laser vaporisation) or an electrocoagulation device (for diathermy) may be inserted. After laparoscopic excision of endometriosis tissue, the laparoscope and other instruments are removed, the gas is allowed to escape and all incisions are closed with a suture or two. The American College of Obstetricians and Gynecologists rates electrocoagulation and laser treatment as equally good options for destroying endometriosis at laparoscope.
Long-term information about the efficacy of surgical approaches in removing endometriosis and reducing its symptoms suggests that they may be about twice as effective as drug therapies. Success rates are around 80% with surgery and about 40% with drug treatments. Whichever technique is under consideration, women should be aware of the risks of these procedures. General anaesthesia can cause nausea, vomiting and impaired concentration for some time after surgery. The potential complications of excisional surgery with or without laparoscopy include bleeding, infection, damage to internal organs and the resultant need for another operation to repair any damage. Following laparoscopy, some discomfort is normal for a few days. Pain in the shoulders, neck or abdomen may occur if the gas used within the abdominal cavity is not removed completely. Very occasionally, a life-threatening air embolism occurs, in which a bubble of air enters the bloodstream and produces an obstruction in the heart or elsewhere.
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