If you are suffering from recurrent bouts of severe lower abdominal pain, pelvic pain, lower back pain, accompanied by painful, abnormally heavy, and irregular menstruation, with an uncomfortable sensation during sex, your doctor might investigate your case for endometriosis. Let us understand endometriosis in detail.
The inner lining of the uterus is called the endometrium. When the tissue that forms the endometrium begins to appear in areas outside the uterus, such as the fallopian tube or the peritoneum, it is called endometriosis. If the tissue is present in the ovary, it will form a lump of cells like a cyst, and this situation is called Endometrioma. This cyst or lump may appear as a palpable mass in the lower abdomen over the ovary.
This condition is painful, and there is a high chance that it will interfere with your body’s hormonal system, thus interfering even with fertility. Moreover, in most cases, the condition is not even detected for a long time since the size may vary from as small as 2 cm to as large as 8 inches.
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What are the Symptoms Endometriotic Cyst Removal?
The following are some symptoms of this condition:
- ● Lower abdominal pain
- ● Lower back pain
- ● Pelvic pain
- ● Irregular, painful, and excessive menstruation
- ● Unable to bear children
- ● Discomfort during sex
What are the Treatment of Endometriotic Cyst Removal?
The treatment for this condition consists of three approaches:
- ● No medical intervention: In some cases, waiting for 6-8 weeks for the cyst to dissolve on its own might be possible. Such patients do not require further medical intervention.
- ● Hormonal therapy: In this method, patients are given GnRH agonists that put the ovaries temporarily in a phase where they will not produce estrogen. This gives relief from several symptoms. As it is less invasive, it is often preferred as the primary method to treat patients with endometrial cysts.
- ● Surgery: In modern-day medicine, the most appropriate approach for a patient with endometriosis is laparoscopy instead of open surgeries. The most important reason patients and doctors prefer laparoscopy over open surgery is the much less invasive nature of laparoscopy and relatively shorter recovery time. Let us understand laparoscopic surgery in greater detail and how it is used to treat endometrial cysts.
This is a procedure performed by a trained gynaecologist or surgeon to get a clear view of your internal organs and diagnose the presence of abnormalities such as endometriosis. Though this procedure is also used to diagnose endometriosis, a negative laparoscopy still does not mean the absence of endometriosis or endometriotic cysts. As mentioned earlier, these cysts can be as small as 2 cm. Hence, it is very easy to miss such cysts when looking at all the other internal organs and structures in and around the abdomen.
Laparoscopic surgery is performed only after medicines fail or in cases where both the patient and the doctor feel it is appropriate to opt for surgery directly. This can be relevant when the pain is unbearable, or the cysts are larger than 1.5 inches. The need for surgery exists because the chances of complications related to such cysts, such as twisting or breaking open of the cyst, are high.
What are the Procedure Associated with Endometriotic Cyst Removal?
1. Preparation for the surgery
- ● You will be advised to fast for at least 8-9 hours before the surgery.
- ● Anaesthesia: Usually, general anaesthesia will be administered, meaning you will not be awake during the procedure. However, occasionally, local anaesthesia or spinal anaesthesia may also be administered as an alternative. This means you will be awake during the surgery but will not feel pain.
2. During the surgery
- ● This procedure is performed by trained hands, a gynaecologist, or a surgeon.
- ● Initially, an incision is made just below the belly button. This incision is used to insert a cannula into the abdomen. Through the cannula, a gas is released in the abdomen (usually carbon dioxide or nitrous oxide), and the abdomen is fully inflated. This separates the abdominal walls from the viscera to provide a clear view to the surgeon.
- ● After this, the laparoscope is inserted through the same incision. A laparoscope is a long, thin tube with a camera fitted at the end. The camera projects pictures of the internal abdominal viscera onto a screen. The surgeon thus gets a clear view of abnormalities, cysts, or other conditions which otherwise remained undetected.
- ● Once the laparoscope is in and the surgeon sees an endometrial cyst, one or two more incisions are made nearby to allow the entry of a few instruments into the abdominal cavity. These instruments may be inserted for various reasons, such as cutting off and removing the cyst, taking a sample for biopsy, or removing fluid from the cyst.
- ● The endometrial cyst removal can be done in the following ways: Excision- Cutting and removing the tissue or Endometrial Ablation – The tissue lump (cyst) is destroyed in one of the many ways such as freezing, heating, laser, or electricity (electrocautery).
- ● After the procedure, the surgeon seals the incision with a few stitches, usually resulting in little to no scar tissue formation. The entire procedure takes 40-45 minutes at the most.
3. Post-surgical precautions
- ● This procedure is usually an outpatient procedure, meaning you will return home after the procedure the same day. Very rarely, you may need to stay overnight.
- ● A family member or someone else should be present to take you home after the surgery and stay with you.
- ● Taking a shower is not advised for at least 48 hours to give the stitches time to heal.
- ● Excessively strenuous activities such as stretching, lifting, bending, or sex should be avoided after surgery for at least 2-4 weeks. You should consult your doctor before resuming these activities.
It has been observed that more than 70% of women under the age of 24 who underwent laparoscopic cyst removal were able to conceive and give birth again. Therefore, the chances of your fertility returning are high.
What are the Risks Associated with Laparoscopic Surgery - Endometriotic Cyst Removal?
This surgical procedure has no additional side effects other than those seen in normal surgical procedures. These effects or risks are:
- ● Mild tenderness in the area around the stitches
- ● Redness around the area
- ● Sometimes some internal injury during the surgery may manifest in a few days after the surgery. Thus, staying in touch with your doctor if any of these signs appear is crucial.
- ● Stitches, if not tied properly or due to excess stress on them, may loosen and open up.
- ● Nausea and vomiting due to the anaesthetics
- ● Hematoma around the stitch
- ● Visceral perforation by the instruments
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What can be expected post laparoscopic surgery?
You might experience the following:
- ● Nausea due to the anaesthesia used
- ● Tenderness and pain around the incision
- ● Pain around the belly button
- ● Shoulder tip pain as a consequence of the carbon dioxide used
- ● Abdominal cramping or pain
Why do doctors prefer laparoscopic surgery for the removal of endometrial cysts over open surgery?
Since the recovery time after laparoscopic surgery is much shorter than open surgery and the pain and discomfort are lower in a laparoscopic procedure, doctors prefer laparoscopic surgery over open surgery.
What precautions must be taken post laparoscopic surgery?
Most of the patients experience pain in some form after surgery. Therefore, they are prescribed certain pain medications such as NSAIDs along with narcotics. These drugs are given for pain management. Activities that may stress your stitches must be avoided for at least a few weeks post-surgery. Sex should be avoided for at least 4 weeks.
What are the chances of my fertility returning after Laparoscopic Surgery?
It has been observed that more than 70% of women below the age of 24 who underwent Laparoscopic Surgery conceived after the procedure and delivered a healthy baby. This indicates laparoscopic surgeries have a high success rate.