Our Summary

Endometriosis is a condition where tissue similar to the lining of the uterus is found outside the uterus, causing pelvic pain. However, not all types of endometriosis lesions (abnormal tissue growth) are painful. The pain from endometriosis can be due to a variety of factors, such as inflammation, nerve activation, adhesions (bands of scar tissue), and nerve infiltration. The severity of the lesions does not always correlate with the level of pain experienced.

To diagnose the cause of the pain, a procedure called laparoscopy, which allows a surgeon to see inside the abdomen, is necessary. Imaging tests like ultrasound or MRI can’t rule out endometriosis. The preferred treatment option is surgical removal of the lesions. However, treating the condition with medication without a confirmed diagnosis could miss other diseases and may lead to chronic pain if the medication isn’t completely effective.

The surgical techniques to treat endometriosis depend on the type of lesions. Smaller, less severe lesions can be destroyed to prevent progression to more severe disease. Typical lesions need to be removed or vaporized, as their depth can be underestimated. Large, painful cysts in the ovaries require careful removal or destruction to avoid damaging the ovary. Larger cysts may need more complex surgery or removal of the ovary.

Deep endometriosis, which affects other organs like the bladder, ureter, or bowel, is challenging and risky to remove. The type of surgery varies, ranging from excision and suturing, to using a circular stapler to remove a disc of tissue, or even resection anastomosis, which involves removing a section of an organ and then reattaching the ends.

The goal of surgery is complete removal of the lesions, preventing the formation of adhesions and recurrence of endometriosis. There is also a question of whether large nerves should be explored during surgery. This paper is based on expert opinion, as randomised controlled trials have not been conducted due to ethical considerations.

FAQs

  1. What is the recommended treatment for endometriosis and associated pelvic pain?
  2. Why is surgical removal preferred over medical therapy for treating endometriosis?
  3. What indications and techniques are used in the surgical removal of endometriosis lesions and cysts?

Doctor’s Tip

After ovarian cyst removal, it is important to follow your doctor’s post-operative instructions carefully. This may include taking prescribed pain medication, avoiding strenuous activities for a certain period of time, and attending follow-up appointments to monitor your recovery. It is also important to report any unusual symptoms or complications to your doctor promptly. Following these guidelines can help ensure a smooth recovery process and minimize the risk of complications.

Suitable For

Patients who are typically recommended for ovarian cyst removal include those with:

  1. Symptomatic ovarian cysts that are causing pain or discomfort
  2. Large ovarian cysts (greater than 6 cm) that are at risk of complications such as torsion or rupture
  3. Endometriomas (cysts containing endometrial tissue) that are causing symptoms or affecting fertility
  4. Ovarian cysts that are suspected to be cancerous or precancerous
  5. Recurrent ovarian cysts that are causing persistent symptoms
  6. Ovarian cysts that are affecting the function of the ovary or causing hormonal imbalances

It is important for patients to undergo a thorough evaluation by a healthcare provider to determine the best course of treatment for their specific situation. Surgery, such as laparoscopic cystectomy, may be recommended in cases where conservative management options have been unsuccessful or if there are concerns about the potential risks associated with the cyst.

Timeline

  • Pre-operative:
  1. Patient presents with symptoms such as pelvic pain, bloating, irregular periods, and difficulty urinating or having bowel movements.
  2. Patient undergoes physical examination, pelvic ultrasound, and possibly MRI or CT scan to confirm the presence of an ovarian cyst.
  3. Surgery is recommended if the cyst is large, causing symptoms, or if there is suspicion of malignancy.
  • Day of surgery:
  1. Patient undergoes laparoscopic or open surgery to remove the ovarian cyst.
  2. Surgery may involve cystectomy (removal of the cyst), oophorectomy (removal of the ovary), or salpingo-oophorectomy (removal of the ovary and fallopian tube).
  3. Surgery is typically performed under general anesthesia and may require an overnight hospital stay.
  • Post-operative:
  1. Patient may experience pain, bloating, and fatigue in the days following surgery.
  2. Patient is prescribed pain medication and instructed on how to care for the incision site.
  3. Follow-up appointments are scheduled to monitor recovery and ensure there are no complications.
  4. Patient may resume normal activities gradually as advised by their healthcare provider.
  5. Patient may experience relief from symptoms such as pelvic pain and bloating after recovery from surgery.

Overall, the timeline of a patient’s experience before and after ovarian cyst removal involves diagnosis of the cyst, surgery to remove it, and post-operative recovery and monitoring for any complications.

What to Ask Your Doctor

  1. What are the potential risks and complications of ovarian cyst removal surgery?
  2. How long will the recovery process be, and what can I expect in terms of pain and discomfort after the surgery?
  3. Will I need any follow-up appointments or additional treatments after the surgery?
  4. How will the surgery affect my fertility, and are there any potential implications for future pregnancies?
  5. Will the removal of the cyst affect my hormone levels or menstrual cycle?
  6. How likely is it that the cyst will return after removal, and what can be done to prevent recurrence?
  7. Are there any lifestyle changes or precautions I should take post-surgery to optimize my recovery and prevent complications?
  8. Will I need any additional imaging or tests to monitor my condition after the surgery?
  9. What are the alternative treatment options for ovarian cysts, and how do they compare to surgical removal in terms of effectiveness and potential risks?
  10. Can you provide me with more information about your experience and success rate with ovarian cyst removal procedures?

Reference

Authors: Koninckx PR, Ussia A, Porpora MG, Malzoni M, Adamyan L, Wattiez A. Journal: Minerva Obstet Gynecol. 2021 Oct;73(5):588-605. doi: 10.23736/S2724-606X.21.04864-8. Epub 2021 May 12. PMID: 33978353