What is Endometriosis?
Endometriosis is a condition where the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, most commonly on the ovaries, fallopian tubes, bowels, and other areas in the pelvic region. This condition can cause chronic pelvic pain, irregular periods, pain during intercourse, and infertility. Endometriosis can significantly affect the quality of life in women and is often seen in women of reproductive age.
What is Deep Infiltrative Endometriosis (DIE)?
Deep Infiltrative Endometriosis (DIE) is a more aggressive form of endometriosis, where the disease penetrates deeper into the pelvic organs, often affecting the rectovaginal septum, bladder, ureters, and intestines. DIE can cause severe pain and significant organ dysfunction. Diagnosis is typically made through a pelvic exam, transvaginal ultrasound, and advanced imaging techniques such as magnetic resonance imaging (MRI).
Endometriosis Surgery: When and How?
Endometriosis surgery is a treatment option aimed at reducing symptoms, improving quality of life, and managing complications like infertility. The surgery involves removing lesions, releasing adhesions, and restoring organ function. Laparoscopic surgery, a minimally invasive technique, is often preferred, while robotic surgery can be used in more complex cases.
What Are the Risks of Surgery?
Endometriosis surgery, particularly for deep infiltrative endometriosis, carries significant risks:
Ureter Injury: Endometriotic tissue can be located near the ureters, increasing the risk of ureter injury during surgery. This can lead to urine leakage, kidney dysfunction, or even loss of kidney function.
Bowel Injury: In cases where the intestines are affected by endometriosis, bowel perforations or injuries may occur during surgery, leading to serious infections and requiring emergency surgical interventions.
Bleeding: There is a high risk of bleeding during endometriosis surgery, especially when removing deep infiltrative lesions, which may involve damage to major blood vessels.
Infection: Postoperative infection is another risk that can negatively affect the recovery process.
Why Should Surgery Be Performed by an Experienced Surgeon?
Deep infiltrative endometriosis surgery requires working near complex anatomical structures and poses significant risks of complications. Therefore, it is crucial for the surgeon to have a thorough understanding of the anatomy and extensive experience. An experienced surgeon can minimize the risk of ureter and bowel injuries, recognize complications early, and intervene promptly with a multidisciplinary approach if necessary.
Conclusion
Endometriosis, especially deep infiltrative endometriosis, is a complex disease that significantly impacts a patient's quality of life and requires a multidisciplinary approach. Surgical treatment is critical for reducing symptoms and preserving organ function. However, it is vital that the surgery be performed by an experienced surgeon to prevent and manage potential complications effectively.
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