Preparing for Your Surgery: Laparoscopic Excision for Endometriosis
Endometriosis is a gynecological disorder affecting 1 in 10 women, that is characterized by the growth of endometrial tissue outside the uterus, which can cause pain and infertility. Laparoscopic excision is a common surgical treatment option for endometriosis, which involves removing the abnormal tissue using a minimally invasive approach. In this article, we will discuss the considerations that need to be made for laparoscopic excision for endometriosis, what patients should expect of the surgery, how pelvic floor physical therapy can be beneficial both before and after the surgery, and what patients should be aware of regarding the recovery process.
Considerations for Laparoscopic Excision
When considering laparoscopic excision for endometriosis, healthcare professionals need to take into account several factors, including the location and extent of the endometrial tissue, the severity of the patient’s symptoms, and family planning (the patient’s desire for future fertility). The surgical approach may differ depending on the severity and location of the endometrial tissue, with some cases requiring a more extensive excision approach. Patients typically will undergo a pre-operative evaluation, including a medical history review, physical exam, and imaging, to ensure that they are healthy enough for surgery and to identify any potential complications.
Understand that as with any surgery, discussion of the procedure is necessary- benefits and risks should be discussed with your provider. Surgical expertise is an important consideration and laparoscopic excision requires a high level of skill and experience. Many GYNs are not experienced in this type of surgery and as a result, may inadvertently cause damage to vital organs (including the pelvic organs), leading to complications such as bleeding, infection, and bladder injury. Therefore, it’s essential to do your research! Choose a surgeon who has extensive experience in laparoscopic excision and endometriosis. Nancy’s Nook (a Facebook group) is a great resource along with ICare Better (a directory of endometriosis providers).
Expectations
Here are a few things to note going into surgery:
1. Laparoscopic excision is performed under general anesthesia and typically takes a few hours depending on the extent of the endometrial lesions.
2. After the surgery, patients can expect to experience some pain and discomfort, which can be managed with pain medication.
3. Patients may also experience some bloating and gas, which should resolve within a few days. Constipation is also likely due to the surgery and pain medications.
4. Patients can usually expect to be discharged from the hospital within 24-48 hours after surgery.
Pelvic Floor Physical Therapy
Endometriosis is a known cause of pelvic floor dysfunction (PFD). Due to its inflammatory nature, it can impact the tissues, organs, pelvic floor muscles, nerves and overall function within the pelvic region resulting in a range of symptoms including pelvic pain, bowel and bladder and sexual dysfunction.
Pelvic floor physical therapy is a non-invasive treatment approach that can be used to address PFD. IT involves manual therapy, functional mobility work, biofeedback tools, scar mobilization, pelvic floor awareness, relaxation, coordination and when necessary, strengthening.
Before laparoscopic excision, pelvic floor PT can help prepare the pelvic floor muscles for surgery, which can improve outcomes and reduce the risk of post-operative complications. A recent study found that preoperative pelvic floor PT was associated with a significant reduction in postoperative pain and an improvement in sexual function in women undergoing laparoscopic excision for endometriosis.
After laparoscopic excision, pelvic floor PT can help address any residual PFD and improve overall outcomes. A systematic review of studies on pelvic floor PT for PFD after gynecological surgery, including laparoscopic excision for endometriosis, found that pelvic floor PT was effective in improving symptoms of PFD, including urinary and fecal incontinence, and sexual dysfunction.
Even for those persons who have opted to avoid surgical intervention, pelvic floor PT can help with management of symptoms and improving quality of life for individuals. Healthcare professionals should consider referring patients with endometriosis for pelvic floor PT before and after laparoscopic excision to optimize outcomes.
Recovery Process
Recovery can vary depending on the extent of the surgery and healing will be individual as we know everyone is different. Generally, patients can expect to return to normal activities within 2 to 4 weeks but, for some it might take a little longer and, the first 1-2 weeks will be the most uncomfortable. It is important to avoid heavy lifting, strenuous exercise for at least 4 weeks and return to sexual activity once cleared by the surgeon and/ or pelvic floor therapist. It is also important to note potential post-operative complications, as with any other surgery, and seek medical attention if they notice severe pain, heavy bleeding or fever and other signs of infection. Patients should also closely follow their surgeon’s instructions regarding wound care and pain management and adhere to post-op followups as scheduled by their surgeon (usually 1-2 weeks post op and around 4 weeks).
Conclusion
Laparoscopic excision is a highly effective treatment for endometriosis. However, there are several considerations must be made before performing this surgery, including patient selection, surgical expertise, and the location and extent of the endometrial lesions. Pelvic floor physical therapy can be beneficial both before and after surgery for education, to address pelvic pain, function and address adhesions. With appropriate evaluation, preparation, and management, laparoscopic excision for endometriosis can be an effective treatment option for patients with endometriosis.
References:
1. American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 214: Endometriosis in adolescents.
2. Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol. 2018;131(3):557-571.
3. Berghmans B, et al. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000;85:254-63.
4. FitzGerald MP, et al. Pelvic floor muscle therapy for patients with symptoms of pelvic floor dysfunction after gynecologic surgery: a randomized controlled trial. Obstet Gynecol. 2008;111(4): 853-62.
5. Huang Q, et al. Pelvic floor muscle training for female urinary incontinence: a systematic review and meta-analysis. World J Urol. 2021;39:781-794
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