What is an Endometriosis Excision?

Endometriosis is a chronic inflammatory disorder in which endometrial tissue grows outside the uterus in the pelvic cavity. While medications may improve endometriosis symptoms, the condition is best treated surgically. Excision of endometriotic lesions or nodules involves cutting out (excising) visible areas of endometriosis via a minimally invasive laparoscopic robotic surgery. Minimally invasive endometriosis excision can preserve fertility and hormone production. 

Laparoscopic Excision (LAPEX) allows for the disease to be meticulously excised – cut out – from all areas, without damaging surrounding structures or removing otherwise healthy organs. While not every patient is a candidate for this type of endometriosis excision, LAPEX has been proven effective in alleviating pain and improving quality of life for many patients.

How do you prepare for an Endometriosis Excision?

The specific instructions depend on the type of your endometriosis procedure. In preparation for your Endometriosis Excision your Viva Eve Ob/Gyn may:

  • Adjust or discontinue some of your medications
  • Ask you to arrange for someone to pick you up from the hospital and stay with you for at least 24 hours after the surgery.
  • Order a bowel preparation, or “bowel prep,” which involves taking medications to empty the bowel. It can be an unpleasant, but it helps the surgeon safely remove endometriosis lesions from the gastrointestinal tract.
  • Ask you to avoid all food and drinks (even clear liquids) for at least six hours before your surgery
  • Ask you to refrain from drinking alcohol for 48 hours before the procedure because alcohol affects how your body absorbs anesthesia and your blood’s ability to clot.
  • Ask you to take a pregnancy test on the day of the procedure. Pregnancy should be ruled out prior to gynecologic surgery in all women of reproductive age
  • Recommend that all metallic jewelry be removed to prevent complications, as well as loss of the jewelry 

Why is an Endometriosis Excision performed?

While endometriosis has no cure, proper and complete laparoscopic excision, followed by appropriate medical management, allows for better pain control and the preservation of fertility.

What can you expect during an Endometriosis Excision?

There are several endometriosis treatment options, including laparoscopy and laparotomy. The best option for you depends on the severity of your condition and your unique situation. The majority of patients who need this surgery will undergo laparoscopy.

During laparoscopic endometriosis surgery:

  • An anesthesiologist will place you under general anesthesia and monitor your vital signs.
  • A surgeon will create a small incision in your belly button or another part of your abdomen (in some cases, they might need to make more than one incision).
  • They’ll use gas to inflate your belly and place you in an inverted position, so the laparoscope has a clear view.
  • Your surgeon will insert the laparoscope through the incision.
  • They’ll use the laparoscope to find areas of endometriosis.
  • They’ll attach special instruments to the laparoscope to remove any affected tissue.
  • After the affected tissue is removed, they will close the incisions with stitches.

Laparatomy is considered a major abdominal surgery and uses larger incisions than laparoscopy.

What is the followup and recovery like for an Endometriosis Excision?

Patients who had laparoscopy are able to go home from the hospital the same day after resting in a recovery area and being cleared by the medical team. They will likely feel tired for a few days, but should be able to return to normal routines in about two weeks, though for some patients it could take longer.

Patients who undergo laparotomy usually need several weeks to recover because the procedure is more invasive. Your Viva Eve gynecologic surgeon will give you a list of detailed post-operative guidelines.

What are the potential costs for an Endometriosis Excision?

Covered by insurance – not sure how to answer. There might be a portion not covered. 

What are the potential risks for an Endometriosis Excision?

Endometriosis excision has risks similar to any type of gynecologic surgery. These may include: bleeding, damage to the walls of the uterus and other organs, infection, allergic reaction to the anesthesia, blood clots, nausea and vomiting after surgery, etc. 

Are there procedures related to an Endometriosis Excision?

Hysterectomy – removing reproductive organs such as the uterus and fallopian tubes – is a major operation that’s only recommended as a last resort for women living with endometriosis after less invasive surgical and medical treatments have been unsuccessful.  A hysterectomy is a major surgery with permanent effects, and it’s not always a cure — the condition and related pain can return. If endometriosis is affecting organs other than the uterus, or is causing pain within adjacent nerves or muscles, simply removing the uterus may not reduce the pelvic pain. 

Taking out both the ovaries (oophorectomy) and the uterus (hysterectomy) usually relieves the discomfort of endometriosis, but can lead to early menopause with its own often unpleasant symptoms.

A hysterectomy may be done abdominally, laparoscopically, or vaginally.

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