Laparoscopy for pelvic pain
Overview
A laparoscopy for chronic pelvic pain offers people many advantages over traditional surgery. With laparoscopic surgery, people usually have shorter hospital stays and quicker recovery times because it is a simpler, less invasive procedure.
Preparing for a Laparoscopy
Laparoscopy for chronic pelvic pain is usually performed on an outpatient basis, meaning that you go home the day of your surgery.
For your particular situation, you will be given specific instructions as to where and when to arrive at the medical facility, how to prepare for your laparoscopy, and what to expect the day of and the days following the laparoscopy.
The Laparoscopy Surgery
As part of a laparoscopy for chronic pelvic pain, a small incision, or cut, will be made in or just below your belly button. A tube, called a trocar, will be inserted into your abdomen (stomach). The laparoscope will then be inserted. Through this, your medical provider will view the inside of your abdomen on a video screen. The laparoscope can also take pictures of the laparoscopy.
If your medical provider finds something abnormal during the examination, the laparoscopic surgery will then continue. Occasionally, two or three small incisions may need to be made just below the navel for other instruments. The specific method used to remove the problem will be based on what is found, its size, and location.
After Laparoscopy for Chronic Pelvic Pain
When you leave the hospital after a laparoscopy, you will get special instructions. Some instructions will be about how to take care of your body and your female organs. Some instructions will be for medicines you are taking and what kinds of exercise and actions you can do. Be sure to ask questions or have the instructions repeated if they don’t make sense.
Expected Results
The specific results of laparoscopy for chronic pelvic pain will depend upon what happens during the procedure and what is found. You can expect your medical provider to have gained valuable information about your particular internal organs, including your pelvis, ovaries, and fallopian tubes, after the laparoscopy.
Abnormalities related to chronic pelvic pain are found in an average of 70 to 80 out of 100 laparoscopies, and this is usually if the pain has been in the same location for at least six months.
Laparoscopy for endometriosis
Overview
Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. If the surgeon needs better access, he or she makes one or two more small incisions for inserting other surgical instruments.
If your medical provider recommends a laparoscopy, it will be to:
View the internal organs to look for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a “no endometriosis” diagnosis is never certain. Growths (implants) can be tiny or hidden from the surgeon’s view.
Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary (endometrioma), it is likely to be removed.
Laparoscopy procedure
You will be advised not to eat or drink for at least 8 hours before a laparoscopy. Laparoscopy is usually done under general anesthesia, although you can stay awake if you have local or spinal anesthetic. Agynecologist or surgeon performs the procedure.
For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide). The gas pushes the abdominal wall away from the organs so that the surgeon can see them clearly. The surgeon then inserts a laparoscope through a small incision and examines the internal organs. Additional incisions may be used to insert instruments to move internal organs and structures for better viewing. The procedure usually takes 30 to 45 minutes.
If endometriosis or scar tissue needs to be removed, your surgeon will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery).
After the procedure, the surgeon closes the abdominal incisions with a few stitches. Usually there is little or no scarring.
What To Expect After Surgery
Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:
Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
Endometriosis pain that has continued or returned after hormone therapy.
Severe endometriosis pain (some women and their medical providers choose to skip medicine treatment).
An endometriosis cyst on an ovary (endometrioma).
Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.
When laparoscopy may not be needed
Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis. But this is not always needed. For suspected endometriosis, hormone therapy is often prescribed.
How Well It Works
Pain relief
As with hormone therapy, surgery relieves endometriosis pain for most women. But it does not guarantee long-lasting results.
Between 70% and 100% of women report pain relief in the first months after surgery.
About 45% of women have symptoms return within the first year after surgery. This number increases over time.
Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.
Infertility
If infertility is your primary concern, your medical provider will probably use laparoscopy to look for and remove signs of endometriosis.
Research has not firmly proved that removing mild endometriosis improves fertility.
For moderate to severe endometriosis, surgery will improve your chances ofpregnancy.
In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.
Laparoscopy adhesions/scar tissue
Overview
Chronic pelvic pain is a debilitating disease that affects more than 20% of women today. Much of the pelvic pain is caused by scar tissue known as adhesions. Adhesions are bands of scar tissue that connect normally separated pelvic structures. This connection represents a common problem in gynecologic health care which causes incapacitating pelvic pain, infertility, constipation, and dyspareunia (painful intercourse). Patients are more likely to have adhesive disease after an injury. The injury can be caused by surgery, infection, radiation or trauma to the abdominal area.
Causes of Pelvic Adhesions
Previous pelvic or abdominal surgery (most common reason)
History of infection in the abdominal cavity
Endometriosis
History of cancer or radiation therapy
Previous intra-abdominal trauma or bleeding (ectopic pregnancy, motor vehicle accidents, appendicitis)
Laparoscopy ovarian cyst
Overview
When an ovarian growth or cyst needs to be closely looked at, a surgeon can do so through a small incision using laparoscopy or through a larger abdominal incision (laparotomy). Either type of surgery can be used to diagnose problems such as ovarian cysts, adhesions, fibroids, and pelvic infection.
During surgery, a noncancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found.
What To Expect After Surgery
General anesthesia usually is used during surgery.
After a laparoscopy, you can resume normal activities within a day. But you should avoid strenuous activity or exercise for about a week.
After a laparotomy, you may stay in the hospital from 2 to 4 days and return to your usual activities in 4 to 6 weeks.
Why It Is Done
Surgery is used to confirm the diagnosis of an ovarian cyst, remove a cyst that is causing symptoms, and rule out ovarian cancer.
Surgery for an ovarian cyst or growth may be advised in the following situations:
Ovarian growths (masses) are present in both ovaries.
An ovarian cyst is larger than 3 in. (7.6 cm).
An ovarian cyst that is being watched does not get smaller or go away in 2 to 3 months.
An ultrasound exam suggests that a cyst is not a simple functional cyst.
You have an ovarian growth and you:
Have never had a menstrual period (for example, a young girl).
Have been through menopause (postmenopausal woman).
Use birth control pills (unless you are using low-dose progestin-only pills or have missed a pill, which would make an ovulation-related functional cyst more likely).
Your medical provider is concerned that ovarian cancer may be present. In this case, it is also advised that you see a gynecologic oncologist.
How Well It Works
An ovarian cyst can be removed from an ovary (cystectomy), preserving the ovary and your fertility. But it is possible for a new cyst to form on the same or opposite ovary after a cystectomy. New cysts can only be completely prevented by removing the ovaries (oophorectomy).
Risks
Risks of ovarian surgery include the following:
- Ovarian cysts may come back after a cystectomy.
- Pain may not be controlled.
- Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis.
- Infection may develop.
- The bowel or bladder may be damaged during surgery.
What To Think About
Surgery may be recommended if you have a large cyst, cysts in both ovaries, or other characteristics that may suggest ovarian cancer. Ovarian cancer can occur in women of all ages, but the incidence increases after menopause.
Laparoscopic assisted vaginal hysterectomy
Overview
LAVH combines laparoscopy and hysterectomy. Laparoscopy is used to look into the abdomen at the reproductive organs. Hysterectomy is surgery to remove the uterus.
LAVH involves the use of a small, telescope-like device called a laparoscope. The laparoscope is inserted into the abdomen through a small cut. It brings light into the abdomen so that your medical provider can see inside. Tiny instruments are also inserted to perform the procedure. Ligaments that support the uterus are cut with these instruments, and the uterus is removed vaginally.
The benefits of LAVH include a short post-operative recovery time, which can be as little as a few hours after the surgery, to a day or two depending on your condition. Also, many patients can return to work and normal activities within 1 to 2 weeks. Most patients appreciate that LAVH has better cosmetic results, with only tiny scars.
Why It Is Done
Hysterectomy may be needed if you have one of the following conditions:
- Fibroids. Hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
- Endometriosis. In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn’t improve endometriosis, you might need a hysterectomy along with removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
- Uterine prolapse. Descent of the uterus into your vagina can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Hysterectomy may be necessary to achieve satisfactory repair of these conditions.
- Persistent vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can’t be controlled by other methods.
- Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy creates new problems. Seek careful evaluation before proceeding with such major surgery.
- Gynecologic cancer. If you have a gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
Risks
Most women do not have complications after a hysterectomy. But complications that may occur include:
- Fever. A slight fever is common after any surgery.
- Difficulty urinating.
- Urinary incontinence.
- Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks following a hysterectomy is expected. But call your medical provider if bleeding continues to be heavy.
- The formation of scar tissue (adhesions).
Rare complications include:
- Infection.
- Blood clots in the legs (thrombophlebitis) or lungs (pulmonary embolus).
- Injury to other organs, such as the bladder or bowel.
- A collection of blood at the surgical site (hematoma).
You may have other physical problems after a hysterectomy. In some women, the pelvic muscles and ligaments that support the vagina, bladder, and rectum may become weak. The weakness may cause bladder or bowel problems, such ascystocele, urinary incontinence, or rectocele. Kegel exercises may help strengthen the pelvic muscles and ligaments. But some women need other treatments, including additional surgery.
Your medical provider will tell you how long you should wait after surgery before engaging in sexual intercourse. Pain during intercourse (dyspareunia) may occur if your vagina was shortened during your hysterectomy. Changing positions may help make intercourse less painful. If you continue to have difficulty with intercourse after a hysterectomy, talk with your medical provider.
What To Expect After Surgery
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. Usually the stay in the recovery area is for 1 to 4 hours. You will then be moved to a hospital room. In addition to any special instructions from your medical provider, your nurse will explain information to help you during your recovery.
You will likely stay in the hospital 1 to 4 days after a hysterectomy. About 4 to 6 weeks after the hysterectomy, your medical provider will examine you in her office. You should be able to return to all of your normal activities, including having sexual intercourse, in about 6 to 8 weeks. Some light bleeding or spotting is expected for up to 6 weeks following a hysterectomy. If your vaginal bleeding is heavier or different than what you were told to expect, call your medical provider.
After you have a hysterectomy, you will not be able to become pregnant.
After a hysterectomy, call your medical provider if you have:
Chest pain, a cough, or trouble breathing.
Bright red vaginal bleeding that soaks two or more pads in an hour or forms large or painful clots.
Pain or tenderness, swelling, or redness in your legs.
A fever of 100°F (37.8°C) or higher.
Pain that is not relieved by your pain medicine or pain that is getting worse.
Pus coming from your incision.
Trouble passing a stool, especially if you have not had a normal bowel movement for 3 to 5 days, or if you have mild pain or swelling in your lower abdomen.
Trouble passing urine, pain or burning when you urinate, blood in your urine, or cloudy urine.
Pain, discomfort, or bleeding during intercourse.
Hot flashes, sweating, flushing, or a fast or pounding heartbeat.
What To Think About
It is normal to feel a variety of emotions about having a hysterectomy. These are often based on beliefs about the importance of your uterus, fears about your health or personal relationships, and concerns about your enjoyment of sexual activities after surgery. If you do have sexual problems after your surgery, talk with your medical provider. He or she will be able to help you or direct you to a specialist who can help.
The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.