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Endometriosis

Occurrence

This disorder occurs when small particles of the inner lining of the uterus (the endometrium) implant themselves in places they do not normally belong. During menstruation the endometrium comes loose and will be excreted through the vagina as menstruation blood. In every woman, a small part will also enter the abdominal cavity via the Fallopian tubes. Normally the body will clean this up. In patients with endometriosis, this clean-up process does not function properly. Small particles of endometrium then implant themselves in the peritoneum or on the ovaries or the bladder or intestinal wall. Over time they will become larger and may start bleeding during menstruation. This causes the woman pain. Painful periods are therefore a sign of endometriosis.

Various forms

We recognise macular endometriosis, cystic and nodular endometriosis. At the same time, endometriosis also causes a reaction in the body with the formation of growths.

Macular endometriosis is limited to spots on the peritoneum in the lower abdomen or the organs of the lower abdomen, such as the bladder, ovaries or intestine. These are superficial lesions that cannot be detected via gynaecological examination or echography.
Cystic endometriosis on the other hand can easily be seen via echography. It gives a typical picture of a cyst with a ‘frosted glass’ appearance of the contents.
Nodular endometriosis occurs when endometriosis grows into the underlying layers. We often see this form appear behind the uterus. If this node continues to grow inwards it can sometimes grow through the rear wall of the vagina and even become visible on examination with a speculum.

The body will react to this endometriosis, without being able to clear it up. Thus, growths and adhesions appear in the various organs in the lower abdomen. Ultimately, all the organs in the abdomen can even bond together, such as uterus, intestine, Fallopian tubes, bladder and ureters.

Endometriosis and fertility

Endometriosis can have a negative effect on fertility. On the one hand, through the growths that can prevent the Fallopian tube from receiving an egg during ovulation, or can block the Fallopian tube itself. On the other hand, the clean-up process that does not function properly in patients with endometriosis can result in large numbers of white blood cells (clean-up cells) being present at the point where sperm cells and eggs normally meet. This negatively affects the chance of fertilisation.

Treatment

There are hormonal and surgical treatments. Hormonal treatments cannot cure the disease process but can curb it. The disadvantage of this treatment is that it stops the woman’s cycle (and therefore it is not possible to become pregnant during treatment) and that the process resumes once treatment is stopped.
In most cases, surgery is able to radically remove the endometriosis.
For cystic and nodular endometriosis, this is the only way to treat the disorder.

Laser surgery for endometriosis

The gynaecology department of Sint-Jan clinic has a CO2 laser for treating endometriosis. The CO2 laser is an instrument that focuses high-energy light in a small area. The cells hit by the light will be heated up to such an extent that they literally turn to smoke (vaporise). The major benefit is that this is an extremely precise technique that does not damage adjacent tissue. Perfect, therefore, if the normal anatomy has to be restored.

Practical info : your doctor will refer you to one of the laser surgeons of the gynaecology department with specific experience in the field for an operative laser laparoscopy. You will be given an appointment to discuss the arrangements for the operation and the planning.
The operation involves inserting a tube (laparoscope) into the abdominal cavity via a small incision in the navel. The abdominal cavity is filled with CO2 gas to create an area which can be examined. Operating instruments can be inserted through further openings of approximately 0.5 cm at the bottom of the abdomen. In this way all manner of operations can be carried out without conspicuous scarring.
The operation is carried out in the day surgery. You will receive a brochure describing how the day surgery operates.
Your health must be assessed before any surgical intervention. The surgeon will generally discuss this with you. A blood sample is always required to determine blood group and for a blood clotting test.
The risks of the operation are limited. There is a chance of infection (<1%), of bleeding (bruise on the skin or internal bleeding) (<1%), of accidentally perforating an adjacent organ such as the bladder or intestine (extremely rare). Very occasionally it may be necessary to interrupt the operation and proceed with a classic operation via abdominal incision.