Examinations and ultrasounds can help a doctor identify endometriosis, but a laparoscopy is the only way to diagnose it definitively.
Endometriosis causes tissue similar to that which lines the uterus to grow elsewhere in the body.
Endometrial tissue can respond to hormones, which can cause the growths to enlarge and bleed. The growths, also called lesions, can lead to lasting, severe pelvic pain, cramping, and inflammation. The condition can also cause scar tissue, bowel symptoms, and infertility.
It can be difficult or impossible for doctors to detect these growths using noninvasive imaging techniques, such as ultrasounds. As a result, the best way to diagnose the condition is a laparoscopy.
This involves a surgeon making small incisions in the abdomen and inserting a tiny camera. This allows them to look for lesions and remove them with surgical instruments, if possible.
Below, learn more about a laparoscopy for endometriosis and what to expect before, during, and after the procedure.
A person usually receives specific instructions about how to prepare. These may include:
- arranging for someone to pick the person up from the hospital and stay with them for 24 hours after the surgery
- not eating or drinking for several hours beforehand
- not smoking in the days or weeks leading up to the surgery
- not taking certain medications on the day of the surgery, if the doctor recommends it
Also, a person may not be able to shower or bathe for 48 hours after the surgery, so they may wish to shower just before going to the hospital.
In addition, the doctor may 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.
When a person arrives at the hospital, they first register for the procedure.
Next, a nurse or another healthcare professional provides a hospital gown and compression stockings. These tight socks help prevent deep vein thrombosis.
A nurse inserts an IV line into the person’s hand, which the anesthesiologist later uses to administer the anesthesia.
Before the procedure, the person usually has the chance to ask the surgeon and nurse questions and discuss the risks and benefits of the procedure.
The person receives general anesthesia, so they are completely unconscious throughout the procedure. An anesthesiologist administers these medications and monitors the person’s vital signs.
The surgeon makes small incisions in the person’s abdomen, including near or in the navel to minimize scarring.
They then insert an instrument that fills the abdomen with carbon dioxide gas. This inflation helps the surgeon see the pelvic organs.
Next, the surgeon inserts instruments as needed to identify lesions and remove samples for a biopsy or as a treatment. This may require further incisions.
Finally, the surgeon removes the instruments and closes the incisions, using either stitches or adhesive. They then cover the incisions with bandages or other dressings.
Innovations in surgical approaches allow some doctors to use robotics to perform this procedure.
After the laparoscopy, a nurse wheels the person to the recovery room, where they monitor the person’s vital signs and manage pain levels.
It may take some time for the person to wake from general anesthesia. They remain in the recovery room for a few hours.
Usually, an overnight stay is not necessary, particularly if the purpose of the laparoscopy is to diagnose endometriosis.
However, there are some cases in which an overnight stay is necessary, such as if the endometriosis lesions were extensive and removing them took a long time.
A doctor may prescribe pain medications to help with recovery. Resting and avoiding excess strain on the abdomen can help. For example, avoid lifting, pushing, or pulling heavy objects during the first few weeks of recovery to reduce the risk of a hernia.
The recovery period varies, but if there are no complications, a person may be able to 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 arrange for extra pain medication and period products such as pads. During the recovery, a person should not insert anything into their vagina.
There are many ways to make recovering from a laparoscopy more comfortable. These include:
- Ensuring that a loved one can take the person home safely and look after them for the rest of the day.
- During the ride home, placing a pillow or sweater between the seatbelt and the abdomen to reduce pressure on the wounds.
- Having a bag or bowl ready on the drive home and beside the bed, as anesthesia often causes nausea and vomiting.
- Drinking peppermint tea to help ease any gas pain caused by 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 after the procedure to help expel the gas.
- Stocking up on pads, as light bleeding can occur in the first few days after the surgery. Do not use tampons or insert anything into the vagina during the recovery.
- Taking enough time off work or school. If surgery is extensive, 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. A person may cry or feel like crying as the anesthetic wears off.
It can take an average of 7–10 years from the start of symptoms to receive a diagnosis of endometriosis.
During that time, people may receive a variety of incorrect diagnoses. They may feel as if they have no choice but to “put up with” their symptoms. Finally receiving a conclusive diagnosis can be an emotional experience.
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. Though the incisions involved are small, a laparoscopy is an invasive procedure that carries risks.
As a result, doctors typically use noninvasive methods to rule out other conditions first. For example, they may use imaging scans, such as an ultrasound, to look for ovarian cysts or fibroids, which can cause similar symptoms.
If a doctor suspects that a person may have endometriosis, they may prescribe hormonal medications, such as birth control pills or gonadotropin-releasing hormone agonists. People with endometriosis often find that their symptoms improve due to this treatment.
However, even with hormonal treatment, some symptoms can persist. Also, not everyone is a candidate for this treatment. For example, people with certain health conditions cannot take medications that contain estrogen, as it can increase their risk of stroke.
A doctor may recommend a laparoscopy for endometriosis if a person
- pain during intercourse
- chronic pelvic pain
- problems urinating
- pain during bowel movements
During the procedure, a surgeon can confirm the diagnosis of endometriosis and remove some lesions. This may ease some symptoms.
While there is no cure for endometriosis, a laparoscopy is an effective treatment for some people.
Any invasive surgery carries risks. A doctor should discuss these with the person before the procedure.
One of the most serious risks 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 that involves the bowel.
Other potential complications include:
- injuries to the bladder
- a pelvic infection
- recurrence of endometriosis lesions
- damage to blood vessels
Ideally, if a surgeon removes endometriosis lesions, the person goes on to have less pain and fewer other symptoms of the condition.
Some people may require more than one laparoscopy to remove the lesions, especially if they are extensive.
And, according to the American College of Obstetricians and Gynecologists, about 40–80% of women who have undergone this surgery have endometriosis-related pain again within 2 years.
Many people take medications, such as hormonal therapies, to help control endometriosis symptoms after a laparoscopy. It is important to discuss the many options for reducing pain and other symptoms with a doctor.