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 a range of symptoms, including pain, problems with your bowels, feeling sick, and difficulty getting pregnant.

There are several treatment options for endometriosis. Depending on your symptoms, your consultant gynaecologist may recommend a laparoscopy (keyhole surgery) to remove the endometrial tissue. This type of surgery is effective at relieving pelvic pain, improving 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. As the procedure is irreversible, your consultant will discuss your treatment options with you, ensuring you have the information and support you need to decide what is best for you.

During the operation, you will be under a general anaesthetic. Your surgeon will make a few small incisions in your tummy and insert a laparoscope – a thin, telescopic instrument with a light – to investigate and remove areas of endometrial tissue.

At Cromwell Hospital, your surgeon may also use highly precise robot‑assisted surgery to remove endometrial tissue. This can result in less scarring and a faster recovery after the procedure.

As part of this procedure, your consultant surgeon may remove part or all of the organ affected by endometriosis (where necessary). They may also relieve pressure on nearby structures, such as the ureter or rectum, to help restore normal bowel and bladder function.

Depending on the severity of their case, some patients will also undergo a bowel resection and/or a hysterectomy as part of their treatment.

Depending on the specifics of your procedure, you may be able to go home on the same day. However, if you have had more extensive surgery, you may need to stay in hospital for a few nights to recover.

In the first few days after the operation, it is common to experience some pain, as well as nausea or vomiting. These symptoms usually settle within a day or two and can be managed with appropriate pain relief medication. You may also experience some vaginal bleeding, which can last for one to two weeks.

One of the main advantages of keyhole (laparoscopic) surgery is a quicker recovery. Most patients are able to return to their normal activities within two to eight weeks, depending on the nature and complexity of the procedure.

If you have ever undergone bowel surgery, there is a small risk of bowel injury. In rare cases, this may require further surgery, including a return to theatre. Your surgical team will discuss these risks with you in detail before your procedure.

Your consultant gynaecologist will also discuss with you how best to prepare for your operation.

You may need to carry out bowel preparation the day before your surgery. Your consultant will let you know if this is required and will arrange it for you if appropriate.

In some cases, your consultant may recommend a course of treatment – such as hormonal medication – for a few months before surgery to help make the endometriosis less active. Alternatively, they may suggest postponing treatment initially to see whether your symptoms improve on their own.

You will also be advised not to eat or drink for several hours before your operation. Clear instructions will be provided to ensure you are safely prepared for surgery.