Fertility Preserving Surgery

Some surgeons will avoid carrying out excisions of the endometriosis which are close to the organs, like the bowels, bladder, or ureters, to avoid any risks associated with surgery around these areas.  By doing this, the endometriosis closer to the site will carry on as it has been previously, with the same progression, which can result in further damage to the organs and an incomplete resumption of a ‘normal quality of life.’

Wide complete excision means that all the endometriosis disease, including that which is attached to the organs, including bowels, bladder, or ureters, will be removed by a careful surgical technique which provides an assurance of safety and more importantly, assurance of complete removal of the disease.  By doing this, it provides further assurance of normal organ function, protection of the organs from further damage of the endometriosis, and a much better resumption of a normal quality of life as the patient becomes free from endometriosis.

It is very important with the surgical technique, to reduce the possibility of adhesion formations (scar tissue formations).  Adhesions can result in problems with fertility and problems with bowel function.  By adopting the microsurgical technique, the likelihood of adhesion or scar tissue formations is reduced significantly.  This is the way forward for not only achieving a good quality of life following the surgery but also to be certain that future fertility and organ function is preserved and enhanced.

When endometriosis surgery is carried out, it is very important to take into consideration, the anatomical effect of the endometriosis on the fertility potential.  It is important for the surgeon to free the tubes, ovaries and the access between the tubes and ovaries.  By doing this, the tubes and ovaries become anatomically in position which allows natural pregnancy to happen.

It is also very important that during the surgery itself, particularly when dealing with endometriosis in the ovary, to preserve the ovarian function by avoiding damage to any existing ovarian tissue.  By doing this the ovarian function will not only be preserved, but also protected from any further damage by endometriosis.

It has been known, that with the right endometriosis surgery, it can significantly improve the fertility outcome potential for those who are seeking fertility and have endometriosis.

There are two lines of surgical management for endometriosis, these are: –

1. Excision, which means removal of the disease.
2. Ablation, which means damaging the disease using any form of energy like diathermy or laser.

The excision method is the treatment choice of the Endometriosis Clinic, as it has been recommended by most of the established authorities. The reason for this is that it allows for the complete removal of visible endometriosis disease.  By doing this, the pelvis will be endometriosis-free following the procedure, reducing the possibility of further irritation from endometriosis and further progression of the disease damaging the nearby organs or nerves.

The advantages of excision over ablation are: –

1. With the ablation technique, there is no guarantee that the deeper part of the legion will be damaged by the energy, therefore the surviving part of the disease will carry on growing, causing further irritation and progression.
2. The ablation technique will not be able to deal with endometriosis of significant thickness or endometriosis that is infiltrating organs like the bowels, bladder or ureters.
3. Excision enables tissue to be taken and sent for histological examination. Doing this allows us to identify: –

• Confirmation of diagnosis of the disease.
• Whether the disease is of normal or abnormal behavior.

When endometriosis is removed, there is a possibility of damaging pelvic nerves which might have some impact on the bladder or bowel function.  Of course, endometriosis itself, which is infiltrating may damage the nerves, it is therefore very important that when the surgery is done, it is done in a conservative way that will save the nerves from any surgical damage.  By doing this, the bladder and bowel function will improve and not deteriorate following the surgery.