While physical examinations and ultrasounds can sometimes help to identify endometriosis, a laparoscopy is the only way to diagnose the disease definitively.
Endometriosis is a condition that occurs when tissue similar to the tissue that lines the uterus grows in other places in the body, forming lesions.
Endometrial tissue responds to hormones, causing some cramping and bleeding during a person's period as their body expels the tissue.
Having this tissue in other locations can cause severe pain, discomfort, bleeding, and swelling.
Endometriosis lesions are difficult or often impossible to detect using non-invasive imaging techniques, such as ultrasounds, so doctors must do a laparoscopy to make a diagnosis.
A laparoscopy involves a surgeon making small incisions in a person's abdomen and inserting a tiny camera that allows them to see inside the abdomen, look for endometriosis lesions, and remove them with surgical instruments if possible.
In this article, learn more about a laparoscopy for endometriosis and what to expect before, during, and after the procedure.
A surgeon will often give a woman specific instructions on how to prepare for surgery. These may include:
- planning for someone to pick them up from the hospital and stay with them for 24 hours
- refraining from eating or drinking anything for several hours beforehand
- refraining from smoking in the days or weeks leading up to the surgery
- avoiding taking certain medications the day of surgery, if the doctor recommends it
Sometimes a doctor will recommend using a special soap in the shower or cleansing wipes on the abdomen the night before or day of the surgery to help to prevent infections.
A person may not be able to shower or bathe for 48 hours following the surgery, so they may wish to shower just before going to the hospital.
Doctors may also order a bowel preparation or "bowel prep," which involves taking medications to empty the bowel.
Bowel prep can be an unpleasant part of preparing for surgery but helps a doctor safely remove endometriosis lesions from the gastrointestinal tract.
A nurse or other healthcare professional will provide a hospital gown and compression stockings. These tight socks will help prevent deep vein thrombosis (DVT).
A nurse will start an intravenous (IV) line in the person's hand, which the anesthesiologist will use later to administer the anesthesia.
The surgeon and nurse will be present before the surgery to answer any questions and discuss the risks and benefits of the procedure.
Surgeons perform laparoscopies using general anesthesia, meaning the individual is completely asleep and unaware of the procedure. An anesthesiologist will provide medications and monitor the person's vital signs during the entire procedure.
The surgeon will make small incisions in the person's abdomen, including near or in the navel to minimize scarring.
The surgeon will then insert an instrument that allows them to fill the abdomen with carbon dioxide gas. Inflating the abdomen with gas helps the surgeon see the pelvic organs.
A doctor may then make further incisions and insert instruments as needed to identify possible areas of endometriosis and remove samples for biopsy or as a treatment.
After the operation, the surgeons will remove the instruments and close the incisions, using either stitches or glue. They will then cover these incisions with bandages or other dressings.
Innovations in surgical approaches mean that doctors may use an operating robot to perform the procedure.
After the procedure, nurses will wheel the person to the recovery room, where they will observe the person's vital signs and manage pain levels.
It may take some time before the person wakes up after general anesthesia. They will stay in the recovery room for a few hours during this time.
Usually, a person will not stay overnight after laparoscopy for endometriosis, especially if it is just a diagnostic procedure.
However, there are some cases in which a person may need to spend the night in the hospital, such as if the endometriosis was extensive and the surgeon took a long time to remove all the lesions.
A doctor may prescribe pain medications to take following the surgery. Resting and avoiding excess strain on the abdomen may also help.
A person should avoid lifting, pushing, or pulling heavy objects during the first few weeks of recovery to reduce their chances of a hernia.
The recovery time varies between individuals, but if there are no complications, most people can return to their regular activities within a week.
A person's first period after a laparoscopy may be heavier and more painful than usual. It is essential to take time to rest if necessary and prepare extra pain relievers and sanitary pads in advance.
There are many ways a person can make their recovery from a laparoscopy more comfortable. These include:
- Ensuring a loved one is available to take the person home safely and look after them for the rest of the day.
- Placing a pillow or sweater between the car seatbelt and the abdomen to reduce pressure on the wounds during the ride home.
- Having a bag or bowl ready on the drive home and beside the bed, as the anesthesia often causes nausea and vomiting.
- Drinking peppermint tea to help relieve gas pain due to trapped carbon dioxide. The gas may cause pain in the belly and shoulder and can take several days or weeks to leave the body.
- Going for slow, gentle walks in the days following the procedure to help expel the gas.
- Stocking up on sanitary pads, as light bleeding can occur in the first few days after the surgery. People should not use tampons or insert anything into the vagina during the recovery period.
- Taking enough time off of work or school. In cases of extensive surgery, some people find it easier to return to work part-time at first, or work from home for 1–2 weeks if possible.
It is common to feel emotional after a laparoscopy. Coming down off of the anesthetic causes some people to cry or feel weepy.
People may also feel emotional or overwhelmed after receiving a diagnosis, as it can take an average of 10 years from the onset of symptoms to receive an endometriosis diagnosis.
During that time, people may have just put up with their symptoms or received a variety of incorrect diagnoses. The relief of receiving a conclusive diagnosis can be an emotional time.
It is essential to take things slowly after a laparoscopy for endometriosis to ensure a complete recovery.
Doctors do not usually recommend a laparoscopy when a person first reports endometriosis-like symptoms because, although the incisions are small, a laparoscopy is still an invasive procedure and comes with some risks.
They will usually try other, non-invasive procedures first to rule out other conditions. For example, they may use imaging scans, such as an ultrasound to look for ovarian cysts or fibroids, which may also be causing pelvic pain.
Sometimes, doctors can spot endometriosis using a transvaginal ultrasound. However, this usually occurs when someone has large endometriotic cysts, known as endometriomas.
Doctors may prescribe hormonal medications, such as birth control pills or gonadotropin-releasing hormone agonists, without knowing for sure if a person has endometriosis.
People with endometriosis often notice their symptoms improve if they take these medications.
However, endometriosis can continue to cause symptoms, even with hormonal treatment.
Symptoms of endometriosis that may warrant a laparoscopy include:
- pain during intercourse
- chronic pelvic pain
- problems urinating
- pain during bowel movements
A surgeon may perform a laparoscopy to confirm a diagnosis of endometriosis, but the procedure also enables a surgeon to remove some of the lesions that may reduce some of the symptoms.
While there is no cure for endometriosis, a laparoscopy can often conclusively diagnose the condition and is an effective treatment for some people.
Any invasive surgery carries some risks. A doctor should discuss these with a person before the procedure.
One of the most serious potential side effects is an injury to the bowel, especially if there are endometriosis lesions in that area. For this reason, only a bowel specialist should perform a procedure around the bowel.
Other potential complications include:
- injuries to the bladder
- pelvic infection
- recurrence of endometriosis
- damage to blood vessels
Ideally, if a surgeon removes endometriosis lesions during surgery, a person will experience fewer symptoms and a reduction in pain.
However, some people may require more than one laparoscopy to remove the lesions, especially if they are extensive.
According to the American College of Obstetricians and Gynecologists, an estimated 40 to 80 percent of women experience pain again within 2 years of having surgery.
Many people will take medications, such as hormonal therapies, to help control endometriosis following the laparoscopy.
A person should talk to a doctor about the many options for reducing pain and other symptoms.