The term "endometriosis" refers to a pathological condition characterized by proliferation of cells of the inner layer of the uterine cavity. Currently, there are several methods for diagnosing and treating the disease, however, laparoscopy is the most effective and informative. It relates to surgical methods, but its advantage is low-invasiveness and minimal risk of complications.
The essence of the method
With endometriosis, laparoscopy is performed for diagnostic or therapeutic purposes. In both cases, the procedure is carried out according to a similar algorithm. The essence of the method is as follows: an instrument equipped with a miniature video camera is inserted into the uterine cavity through a small incision. The image from it is transmitted to a computer monitor, so that the doctor gets the opportunity to assess the state of the inner layer of the organ and finally confirm the diagnosis of endometriosis.
Laparoscopy, which is performed for the purpose of treatment, involves the introduction of another instrument equipped with a loop into the uterine cavity. With its help, the surgeon can remove neoplasms in the form of nodes and dissect adhesions, if any.
Indications
For diagnostic purposes, laparoscopy is rarely prescribed. The procedure is indicated for patients in the following situations:
- all clinical manifestations of endometriosis are present, but the disease is not confirmed in the process of ultrasound;
- for no apparent reason, pregnancy does not occur within 2 or more years;
- the doctor has suspicions regarding the presence of concomitant pathologies that are also not detected by ultrasound.
In most cases with endometriosis, laparoscopy is prescribed for therapeutic purposes. Indications for the procedure:
- focal form of the disease;
- the presence of adhesions that impede the onset of pregnancy or cause intense pain;
- the need to remove the uterus - it can arise if the disease has a neglected form and regularly provokes the development of complications.
In the latter case, with the help of tools, preparation of arteries and blood vessels for laparotomy excision is carried out. This minimizes the risk of severe bleeding.
Despite the fact that laparoscopy is a less traumatic surgical intervention, doctors prescribe it only in cases of emergency.
Contraindications
Like any other method of surgical treatment of endometriosis, laparoscopy has a number of limitations to its implementation. The main contraindications include the following diseases and conditions:
- Intolerance to drugs used as anesthesia.
- Blood coagulation disorders.
- Late stages of obesity, in which it is impossible to access the uterine cavity.
- Disorders of the cardiovascular system.
- The presence of severe scars in the uterus or in the abdomen.
- The tendency to develop adhesions.
- Respiratory system diseases.
- Diabetes.
- Anomalies in the structure of the diaphragm.
- Neoplasms of both benign and malignant nature.
- Pathologies of a viral or infectious nature in the acute stage.
- Dermatological diseases.
- Acute liver failure.
- Relocated abdominal operations in the recent past.
The list of contraindications can be expanded by the doctor. Treatment of endometriosis with laparoscopy is carried out only if no serious pathologies were found in the patient during the examination.
Preparation
At this stage, the doctor's task is to identify possible contraindications for the surgical treatment of endometriosis. To do this, he prepares the patient for a comprehensive examination, including:
- general and biochemical blood and urine tests;
- Ultrasound of the uterine cavity (vaginal examination) - in the process of conducting it, foci of pathology are identified, their size and exact localization are also determined.
Approximately 1-3 months before surgery, hormone therapy is indicated. Often, while taking medication, the foci of pathology are reduced in size, which reduces the duration of the intervention and minimizes the risk of complications. If the patient revealed chronic pathologies during the examination, symptomatic therapy is indicated.
Treatment of endometriosis with laparoscopy is performed on an empty stomach. The last meal before surgery should take place no later than 12 hours. In the morning you need to cleanse the intestines with an enema.
Algorithm
Despite the fact that laparoscopy is a minimally invasive method of intervention, the patient is given general anesthesia. Only after this, the doctor proceeds to remove the foci of pathology.
The algorithm for the operation.
- The surgeon makes several small incisions in the abdominal cavity. Their length does not exceed 2.5 cm. Through punctures, gas is initially introduced into the abdominal cavity. This is necessary in order to spread the organs and provide the maximum degree of visibility.
- Through a single puncture, a laparoscope is inserted. Outwardly, it is a small-diameter tube equipped with a video camera. Using a tool, the doctor assesses the condition of the inner layer of the uterine cavity. If foci of endometriosis are detected, their exact size and localization is determined.
- Through the second puncture, the doctor inserts an instrument equipped with a cutting loop into the organ cavity. With its help, the surgeon dissects the commissures and removes the foci of pathology. If the disease is severe, the doctor decides on the feasibility of a hysterectomy. This term refers to the removal of the uterus. Such an operation is carried out only if the foci of endometriosis destroyed the tissues of the organ and it is impossible to preserve it.
- The final step is to remove the instruments and suture the soft tissue.
The recovery period lasts up to 4 days. At this time, the woman is shown complete peace. Over the next 2 weeks, the patient must periodically visit a doctor. This will help to timely identify the development of complications.
According to medical reviews, endometriosis after laparoscopy may appear again. To prevent relapse, the doctor prescribes a course of hormone therapy. It is also indicated for repeated development of the disease. Most often, the drug is prescribed by the drug "Visanne". With endometriosis after laparoscopy, its active components help prevent the increase of pathological foci in size, which prevents the progression of pathology. The minimum duration of treatment with this drug is 6 months. After this time, the decision on the need for further therapy is made by the doctor.
Possible complications
As a rule, they occur after organ removal. Despite the fact that the re-development of endometriosis is ruled out, numerous cysts can appear on the ovaries (if the latter were not excised). A similar complication is associated with a hormonal surge, which inevitably occurs after a similar operation.
In some cases, endometriosis occurs on the postoperative scar. It manifests itself in the form of intense pain in the abdomen. Gradually, the formation of polyps occurs.
The likelihood of conception of a child after laparoscopy of endometriosis
Pregnancy against the background of the course of pathology, as a rule, does not occur. In this regard, the disease is considered a trigger factor in the development of infertility. However, after laparoscopy of endometriosis, pregnancy in most cases occurs. The most favorable period of conception is 6 months after surgery or immediately after the end of the course of treatment with hormonal drugs.
According to statistics, during the first year, pregnancy occurs in 85% of patients. In this case, the greatest probability of conception falls on the interval between the 6th and 8th months. However, in a quarter of patients, pregnancy occurs in 30-90 days.
To increase the chance of conception, you must follow the principles of a healthy lifestyle and take folic acid. In addition, it is important to avoid getting into stressful situations.
Reviews
For many patients, this type of intervention is the only treatment option. According to medical reviews, with endometriosis, laparoscopy is prescribed only as a last resort, when drug therapy does not bring positive results or there are suspicions of the presence of serious concomitant pathologies. Experts note that the method is highly effective. Most women do not relapse.
According to reviews, patients undergo surgery easily. A few days after the surgery, they can begin to carry out their daily duties.
Finally
Laparoscopic surgery is a less traumatic treatment for endometriosis. During the intervention, the doctor removes the pathological foci and dissects the adhesions, if any. If we take into account statistics, in most women pregnancy occurs within the first year after surgery. There is a risk of relapse, but it is minimal if the patient complies with all the doctor's prescriptions.