Every month when the uterus contracts to squeeze out the endometrial
lining during menstruation, some tissue and blood is propelled
backward through the fallopian tubes and into the abdominal cavity.
Since we have been doing laparoscopies, we have observed that this
backflow probably occurs among all women. However, it does not
always cause problems. Most women's bodies are able to resist the
implantation of endometrial tissue in surfaces surrounding the
uterus. In other women, there are varying degrees of resistance,
leading to anything from mild to severe endometriosis.
Current medical thinking holds that women with endometriosis have
some immunological defect that renders them incapable of rejecting
implantation of misplaced endometrial tissue. In other words, their
immune systems are unable to mount a defense against the implants.
Most
commonly, endometrial implants lodge either in a pouch-like area
behind the uterus called the cul de sac and/or around the fallopian
tubes. Endometrial tissue can also attach itself to the ovaries. If
it does, the monthly blood flow becomes trapped, leading to the
formation of a cyst called an endometrioma. When the endometrial
tissue is forced into the wall of the uterus and takes root, the
condition is called adenomyosis. The blood and tissue shed each
month become trapped in the wall. Adenomyosis can be extremely
painful and may cause heavy bleeding or infertility. The condition
is often indistinguishable from
fibroids.
The Goal of Treating
Endometriosis
-
Relieve pain,
-
Shrink endometriosis or slow its
growth,
-
Remove the endometriosis,
-
Maintain or restore fertility.
Remarkable new drugs as well as some very sophisticated surgical
techniques have made it possible to eradicate endometrial implants
and associated adhesions simply and quickly by endoscopy or
laparoscopy. However, even the latest approaches have their
limitations.
Laparoscopy in the
treatment of Endometriosis
The aim of surgery is to remove as much of the endometriosis as
possible while maintaining the woman’s ability to have children.
Surgery is recommended if:
-
The pieces of endometriosis are
larger than 4–5cm (1.5–2 inches),
-
There are many adhesions or they
are interfering with the normal workings of internal organs such
as the bowel,
-
The endometriosis is blocking the
Fallopian tubes and causing infertility,
-
There is severe pain, which cannot
be controlled with painkillers or hormones.
The endometriosis may be cut away, or destroyed with heat produced
by an electric current or by using a laser. This can often be done
by laparoscopy, using small incisions in the belly and a telescope
to view the inside of the pelvic area (keyhole surgery) done on an
outpatient basis. Surgical devices in use include
Electrosurgery, Laser, Cavitational
Ultrasonic Surgical Aspirator (CUSA), Harmonic Scalpel and others.
Endometriosis-The
Latest Drugs
Two types of drugs are the mainstays of endometriosis
treatment today. They are Danocrine and GnRH agonists. These drugs
have the same effect: They induce a transient block in estrogen
production. Since the endometrial tissue requires estrogen to grow,
endometriosis is temporarily halted.
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