Author: Dr. Melissa McHale, Endometriosis Excision Surgeon in Washington, DC
Endometriosis surgery is like a box of chocolates, you never know what you’re going to get! (That’s the saying, right?) but in all seriousness, endo surgery can be complex and challenging. Which is why every surgeon who does high volume endo surgery will tell you that she does every single case the exact same way. That roadmap isn’t always the same from surgeon to surgeon, but every surgeon has her own. And for good reason – this allows the surgeon to know that no matter how complex the case is, she has a roadmap for accomplishing the core principles of endometriosis surgery – complete survey, normalization of anatomy, and excision of all endometriosis implants. And these are the principles that your surgeon should be able to articulate for you when you lead with an open-ended question such as “how do you approach endometriosis surgery?”
How Should Endometriosis Excision Surgery Be Approached?
Any true expert is going to tell you those exact principles – starting with the survey. Your surgeon will have a plan to look from the diaphragm to the pelvic floor, because chances are, she has navigated this in the exact same order over and over and has a map that guides her through a complete survey of the abdomen and pelvis.
Next, she will understand the common pitfalls of endometriosis surgery – how to manage adhesions, fibrosis, and organs found in places they shouldn’t be. This step is often about preparation. She will have performed at LEAST one imaging modality (MRI or ultrasound) (sometimes both) and interpreted the images for you with her own read, not just going off of what the radiologist wrote. You should be able to see her creating a mental map of what she expects your anatomy to look like based on your imaging, and she should be able to articulate for you what she sees and what implications that might have for your surgery.
Lastly, your surgeon will have the experience to be able to recognize all the different ways endometriosis can look – from the most classic “powder-burn” lesions to the really subtle vesicular lesions. Excision of lesions can be performed using a variety of different tools (robotic instruments, laparoscopic instruments, laser) and as long as your surgeon is adept with her method of choice, she will have the plan and ability to fully excise all endometriosis lesions that she finds.
What is Recovery Excision Surgery Normally Like?
By following our surgical roadmap, high volume excision surgeons can achieve great long-term results for endometriosis patients. However, the immediate post-op period doesn’t look the same for everyone. You may wake up from surgery and already feel a difference – that something that was causing you pain isn’t there anymore. But you may not feel that way.
Similarly, some patients experience their first period as a completely different experience than they had before surgery – others will experience it as possibly even worse than the periods they had preop. None of these are indicators of long-term outcomes, so in those first few weeks it’s important to take it one day at a time and prioritize healing.
The initial post-op period can be rough – you surgeon will discuss with you in advance what symptoms are normal, and what signs you should watch out for that may need evaluation. Your surgeon will have specific guidance for you on getting back to normal activity, and this will be based on the extent of your surgery. You surgeon will check on you to make sure things are progressing after surgery and should discuss what the next steps after surgery should be – a conversation guided by your priorities (such as fertility) and other pain generators (such as pelvic floor dysfunction).
This will ensure that you have the right follow up after surgery to help you get maximum benefit from surgery.
