Cause / Condition
Endometriosis is the presence of tissue on the pelvic peritoneum, in the uterine muscle, or deep in the uterosacral ligaments and cul-de-sac. Occasionally endometriosis may also invade the bladder, bowel, ureter, diaphragm, and intestines. Ovarian cysts may form filled with chocolaty material. Typical symptoms may be pain at menses, urination, defecation, and during sex. Severe forms of endometriosis involving the bowel may cause bowel obstruction or the appearance of blood through the rectum. Similarly, blood in the urine may also be a feature of bladder involvement.
The theory that endometriosis arises from the shed lining of the uterus through “backwards” menstruation is not thought to be universally true. It is more likely that deep or significant endometriosis arises by change of tissue type that may be stimulated by backflow of menstruation (metaplasia theory). What this means is that if adequate resection of these tissues containing the disease is performed, recurrence rate would be low. This is, in fact, our experience.
About the Procedure
All cases of endometriosis including the most severe are performed by laparoscopy. This includes cases where bowel resection has to be performed because of advanced disease of the bowel.
MIMIS is one of the very few centers nationwide with experience in the laparoscopic treatment endometriosis of the bladder, ureter, bowel, and thorax. A bowel prep may be needed when the treatment of the bowel is anticipated.
Most cases are performed on an outpatient basis with discharge from hospital the same day. Other patients stay for less than 24 hours and are discharged the following day. Patients requiring bowel resection stay in hospital for about four days. Return to work may be anticipated after one to three weeks depending on the surgery.
Expectations / Experience
The style of endometriosis resection performed by Drs. Charles Koh and Grace Janik is called “radical excision” and has resulted in lower recurrence rates and repeated surgeries are unnecessary. Hysterectomy is rarely performed except in situations when the uterus is actually involved with endometriosis. The doctors are actively engaged in educating other gynecologists and residents that hysterectomy does not cure endometriosis and is an inappropriate treatment.
Surgery on the bowel may lead to bowel complications and this is true regardless of whether the surgery is performed by laparoscopy or by laparotomy. Improvement in pain is experienced by the majority of patients. A pregnancy rate of over 50% is attainable, depending on the severity of the endometriosis and other related problems.
For more information on laparoscopic treatment for endometriosis contact:
The Milwaukee Institute of Minimally Invasive Surgery
Columbia St. Mary's Hospital Milwaukee
2301 N. Lake Dr.
Milwaukee, WI 53211