Excision of recto-vaginal endometriosis
Laparoscopic or robotic-assisted surgery to remove endometrial tissue from around the rectum and vagina.
What is excision of recto-vaginal endometriosis?
Endometriosis is a complex gyanecological condition which requires a multidisplinary approach and a team of experienced surgeons to get the best outcome for patients. The management approach includes laparoscopy which is to use keyhole surgery to investigate and remove (excise) endometrial tissue that has grown into the area around the rectum and vagina. Your consultant gynaecologist will use a laparoscope, a thin telescopic instrument, inserted through a small incision in your tummy. At Cromwell Hospital, your surgeon can also use the latest robot-assisted surgery to remove endometrial tissue. Robotic-assisted surgery has been linked to less pain and quicker recovery.
Who is suitable for excision of recto-vaginal endometriosis?
Endometriosis is a condition where tissue, similar to the lining of your womb, starts to grow in other places, such as the ovaries, fallopian tubes, bowel, bladder and sometimes lungs. It can cause significant problems, including pain, problems with your bowels, feeling sick and difficulty getting pregnant. There are a range of treatments for endometriosis. Depending on your symptoms, your consultant gynaecologist may recommend a laparoscopy (keyhole surgery) to cut away endometrial tissue.
This type of surgery is effective at relieving pelvic pain, treating bowel symptoms and may increase your chances of getting pregnant. However, endometriosis is a chronic condition and symptoms can return.
Your doctor will also discuss other alternatives such as medical treatment and in severe cases, a hysterectomy. After a hysterectomy you’ll no longer have periods. As the procedure is irreversible, your consultant will discuss your treatment options with you, giving you plenty of time to think about what is best for you.
What does excision of recto-vaginal endometriosis involve?
During the operation, you will be under general anaesthetic. Your surgeon will make small incisions in your tummy and then insert the laparoscope, a thin telescopic instrument with a light. They use the laparoscope to investigate and remove patches of endometrial tissue. At Cromwell Hospital, your surgeon can also use very precise, robot-assisted surgery to remove endometrial tissue from your body. This causes less scarring, and means you will recover more quickly from the operation.
As part of this procedure, your consultant surgeon will, if needed, be able to remove part or all of the organ affected by endometriosis. As part of this procedure, your consultant surgeon will, if needed, be able to relieve pressure on your ureter and/or rectum, so that you can pass urine freely.
Some patients will also undergo a bowel resection and/or a hysterectomy as part of their treatment.
What is the recovery period?
Depending on the specifics of your procedure, you may be able to go home on the same day. If you have had more major surgery, you will need to be cared for in hospital for a few nights. In the first days after the operation, you may experience nausea and vomiting as well as some pain. This should ease within a day or two and can be managed with pain relief medication. You may also experience some bleeding for one or two weeks. The advantage of keyhole surgery is that you recover more quickly. You should be able to return to your normal activities within two to eight weeks, depending on the nature of your procedure.
What can you do to prepare for the procedure?
Your consultant gynaecologist will discuss with you how you can prepare. Sometimes they may advise a course of treatment, such as hormonal medicines, for a few months, to make the endometriosis less active. They may suggest not starting treatment immediately to see if your symptoms improve on their own. You will be advised to avoid eating or drinking for a few hours before the operation.