Deep Infiltrating Endometriosis Surgery

Deep infiltrating endometriosis (DIE) is a debilitating condition where tissue similar to the lining of the womb grows deeply into structures such as the bowel, bladder, uterosacral ligaments, and other pelvic organs. This severe form of endometriosis often leads to symptoms such as chronic pelvic pain , painful or heavy periods, discomfort during intercourse, and bowel or urinary issues . For many women, these symptoms significantly affect their daily lives, which makes it essential to ensure timely and effective treatment.

When medical therapies fail to provide relief or when the condition impacts vital organs, surgery is often the recommended course of action. Surgical treatment for DIE focuses on removing the affected tissue while preserving the function of surrounding organs and, where possible, maintaining fertility. Minimally invasive surgical techniques, such as laparoscopic excision, nodule shaving, and segmental resection are commonly utilised to address the complexities of the condition and improve patient outcomes.

At Dr. Ma Li’s clinic, we understand the physical and emotional challenges that come with deep infiltrating endometriosis. Our team is dedicated to providing compassionate care, utilising evidence-based approaches according to each individual’s needs. Whether you are experiencing severe symptoms or seeking guidance on treatment options, our clinic offers a comprehensive pathway to relief and improved quality of life.

Deep infiltrating endometriosis is a severe form of endometriosis where tissue similar to the womb lining grows deeply into pelvic organs, causing significant pain and complications.

What does Deep Infiltrating Endometriosis Surgery involve?

Deep infiltrating endometriosis surgery is a specialised surgical approach designed to treat cases where endometrial-like tissue has deeply infiltrated pelvic organs and structures. The aim of the surgery is to alleviate symptoms, restore organ function, and, where applicable, preserve fertility. Given the complexity of deep infiltrating endometriosis, the choice of surgical method depends on the location and severity of the condition.

The commonly employed techniques include:

Laparoscopic excision – this minimally invasive method involves removing endometriotic lesions with precision through small incisions. It allows surgeons to excise the affected tissue while minimising trauma to surrounding organs.
Nodule shaving – used when the bowel or other structures are affected, this technique involves carefully shaving off the diseased tissue without penetrating deeply into the underlying organ, which minimises the risk of complications.
Segmental resection – in cases where the endometriosis has significantly infiltrated the bowel, this method involves removing the affected segment and reconnecting the healthy ends, which helps ensure that normal bowel function is maintained.

What does Deep Infiltrating Endometriosis Surgery entail?

The surgical procedure for deep infiltrating endometriosis (DIE) is a meticulous process aimed at excising endometrial-like tissue while preserving the function of surrounding organs. It requires a combination of detailed imaging, careful planning, and precise surgical techniques to ensure optimal outcomes for the patient.

Pre-Surgical Planning

Before the surgery, detailed imaging such as magnetic resonance imaging (MRI) or transvaginal ultrasound is performed to assess the extent of the disease. These scans help map the affected areas, including the bowel, bladder, and other pelvic structures. In some cases, bowel preparation is required if the intestines are involved to ensure a clear surgical field during the procedure.

The Surgical Procedure

Anaesthesia and preparation – the procedure is performed under general anaesthesia. Patients are positioned to allow optimal access to the pelvic region.
Laparoscopic access – the surgeon begins by making small incisions in the abdomen. A laparoscope (a thin, lighted tube with a camera) is inserted through one incision to provide a clear, magnified view of the pelvic cavity. Additional small incisions are made for inserting specialised surgical instruments.
Lesion identification – using the laparoscope, the surgeon carefully examines the pelvic cavity to identify all areas affected by endometriosis. Detailed imaging techniques, like indocyanine green (ICG) fluorescence, may be employed to highlight diseased tissues for precise removal.

Excision and tissue removal

Laparoscopic excision – endometriotic lesions are excised (cut out) from affected organs and tissues, including the uterus, ovaries, bladder, and bowel. The aim is to remove the diseased tissue completely to alleviate symptoms and prevent recurrence.
Nodule shaving – for lesions infiltrating the bowel or bladder, the outer layers of the affected organ are shaved off without compromising its structure. This method is often used for less severe infiltration.
Segmental resection – if the endometriosis has deeply penetrated the bowel or other organs, the diseased segment is removed entirely, and the healthy sections are reconnected (anastomosis).

Throughout the surgery, care is taken to preserve the function of the involved organs. For instance, the ureters (tubes connecting the kidneys to the bladder) are carefully protected during the excision of uterosacral ligament lesions. Once all affected tissue is removed, the instruments are withdrawn, and the small incisions are closed with sutures. The patient is then monitored in a recovery room before being discharged, usually within 24 to 48 hours for laparoscopic procedures.

Following the surgery, patients may be prescribed hormonal therapy to suppress any residual endometriosis and prevent recurrence. Follow-up appointments are essential to monitor recovery and address any concerns.

What are the benefits of surgery for Deep Infiltrating Endometriosis?

Surgery for deep infiltrating endometriosis offers significant relief from symptoms and addresses complications that can severely impact a woman’s quality of life. By removing deeply infiltrated endometrial tissue, surgery provides both immediate and long-term benefits. Key benefits include:

Symptom relief – alleviates chronic pelvic pain, painful periods, and discomfort during intercourse.
Improved organ function – restores normal function of affected organs, such as the bowel, bladder, and reproductive system.
Enhanced fertility – increases the likelihood of conception for women struggling with infertility due to endometriosis.
Reduced recurrence – comprehensive removal of lesions lowers the risk of recurrence compared to medical therapy alone.
Improved quality of life – helps patients return to daily activities without the burden of debilitating symptoms.
Minimally invasive recovery – with techniques like laparoscopic surgery, recovery time is shorter, with reduced scarring and quicker return to normal routines.
Personalised treatment – allows personalised surgical approaches, such as excision, nodule shaving, or segmental resection, depending on the severity and location of the condition.

At Dr. Ma Li’s clinic, we aim to maximise these benefits through detailed surgical planning and expert care, as we empower women to regain control of their health and well-being.

Who is a candidate for Deep Infiltrating Endometriosis Surgery?

Not all individuals diagnosed with deep infiltrating endometriosis (DIE) require surgery. Surgical intervention is typically reserved for those whose symptoms significantly impact their quality of life or when complications arise that cannot be effectively managed through medical treatment alone. Identifying the right candidates for surgery involves a thorough evaluation by a healthcare professional, considering the severity of symptoms, the extent of the disease, and individual health goals. Candidates for DIE surgery typically include those who experience:

Severe or persistent symptoms – patients with chronic pelvic pain, severe menstrual cramps (dysmenorrhea), or pain during intercourse (dyspareunia) that does not improve with hormonal or pain management therapies may benefit from surgical treatment.
Bowel or urinary involvement – women with DIE that affects the bowel or bladder, leading to symptoms such as painful bowel movements, rectal bleeding, constipation, or urinary difficulties, are often candidates for surgery.
Infertility related to Endometriosis – for those struggling to conceive due to endometriosis, surgical excision of lesions can improve fertility outcomes by restoring the normal anatomy and function of reproductive organs.
Complications from DIE – cases where endometriosis has caused organ damage, obstruction, or adhesions (scar tissue) that interfere with daily activities or overall health may require surgical intervention.
Failure of medical management – patients who have not responded to hormonal therapies, including oral contraceptives, GnRH agonists, or progestins, are often considered for surgery.

Additional Considerations

Age and fertility goals – younger women or those wishing to preserve fertility are often recommended surgery to reduce the risk of disease progression and its impact on reproductive health.
Extent of the disease – surgery is often necessary for individuals with widespread or deeply infiltrative lesions that cannot be adequately managed through non-surgical means.
Quality of life – women whose endometriosis symptoms severely disrupt their ability to work, maintain relationships, or perform daily activities may consider surgery as a way to regain control over their lives.

At Dr. Ma Li’s clinic, we carefully assess each patient’s symptoms, medical history, and personal goals to determine if surgery is the most appropriate option. Our team collaborates with patients to develop a personalised treatment plan that addresses their needs while prioritising long-term health and well-being.

People with chronic pelvic pain, severe menstrual cramps (dysmenorrhea), or pain during intercourse (dyspareunia) that doesn’t improve with medical treatment may benefit from surgery for deep infiltrating endometriosis.

What are the risks and complications of surgery?

While surgery for deep infiltrating endometriosis (DIE) can offer significant relief and improve quality of life, it is important to understand that, like any surgical procedure, it carries certain risks and potential complications. These risks can vary depending on the extent of the disease, the surgical method used, and the patient’s overall health. Although rare, the risks associated with DIE surgery include:

Infection – any surgical procedure carries a risk of infection at the incision sites or within the pelvic cavity. This is typically managed with antibiotics and proper wound care.
Bleeding – excessive bleeding may occur during or after surgery, particularly if endometriotic lesions are located near blood vessels. In rare cases, a transfusion may be required.
Damage to surrounding organs – DIE often involves vital structures such as the bowel, bladder, or ureters. Despite the surgeon’s expertise, there is a small risk of accidental injury to these organs, which may require additional repair.
Adhesion formation – scar tissue can develop after surgery, potentially leading to chronic pain or complications such as bowel obstruction.
Recurrence of Endometriosis – although surgery aims to remove all visible lesions, there is a possibility of disease recurrence, particularly in women with severe or widespread endometriosis.
Anaesthesia-related risks – some patients may experience side effects from general anaesthesia, such as nausea, vomiting, or a sore throat. Serious reactions are rare but possible.

Specific risks for surgical techniques:

Nodule shaving – while less invasive to the affected organ, this method may leave microscopic endometriotic tissue behind, potentially leading to recurrence.
Segmental resection – this technique, used for bowel involvement, carries a higher risk of complications such as anastomotic leakage (failure of the bowel reconnection site) or temporary changes in bowel habits.

At Dr. Ma Li’s clinic, patient safety is our top priority. Our surgical team is experienced in performing complex DIE procedures with precision and care. We use minimally invasive techniques to minimise complications and improve outcomes. Following surgery, patients are closely monitored for any signs of complications. Proper postoperative care, including pain management, physical activity guidance, and regular follow-ups, helps reduce risks and supports a smooth recovery.

What to expect before and after the surgery?

At Dr. Ma Li’s clinic, we understand that preparing for surgery can be a daunting experience. That’s why we are committed to guiding you every step of the way, so you feel informed, supported, and cared for throughout the entire process. Here’s what you can expect before, during, and after your deep infiltrating endometriosis surgery.

Your journey begins with a thorough consultation. Dr. Ma Li and her team will review your medical history, assess your symptoms, and explain the surgical plan in detail. Imaging, such as MRI or transvaginal ultrasound, will be used to map the extent of the disease and guide the procedure.

To prepare for surgery, you may be asked to:

Follow a specific diet or fasting instructions the night before.
Undergo bowel preparation if the surgery involves the bowel.
Stop certain medications, such as blood thinners, to minimise bleeding risks.
Complete preoperative tests, including blood work and anaesthesia clearance.

On the day of your procedure, you will be greeted by our friendly staff, who will guide you through the pre-surgical preparations. You will meet your anaesthetist, who will explain the process and ensure your comfort. Once you are under general anaesthesia, Dr. Ma Li and her surgical team will proceed with the planned technique, whether it’s laparoscopic excision, nodule shaving, or segmental resection.

We prioritise precision and safety during surgery, using minimally invasive methods whenever possible to reduce recovery time and optimise outcomes. The procedure length varies based on the complexity of the case, and our team will keep your loved ones updated throughout.

Following the surgery, you will wake up in a recovery room where our nurses will monitor you closely to ensure your comfort and stability. Most patients undergoing laparoscopic surgery are discharged within 24 to 48 hours.

During your recovery, we provide:

Clear instructions on wound care, medication, and activity restrictions.
Support for managing post-surgical discomfort, including pain relief options.
Guidance on returning to normal activities, with a gradual increase in physical activity.

Follow-up appointments will be scheduled to monitor your progress, address any concerns, and discuss long-term management plans to reduce recurrence risk. If hormonal therapy is recommended, Dr. Ma Li will develop a plan that suits your specific needs.

If you are experiencing symptoms of deep infiltrating endometriosis or want to explore treatment options, schedule a consultation with Dr. Ma Li to discuss a personalised care plan according to your needs, and health conditions.

FAQs

Frequently asked questions

How long does the surgery typically take?

The duration of deep infiltrating endometriosis surgery varies based on the extent of the disease but generally ranges from 2 to 4 hours.

Will I need a catheter after surgery?

Depending on the complexity of the procedure and involvement of urinary structures, a temporary catheter may be placed to assist with urination post-surgery.

How soon can I return to work after the procedure?

Recovery times vary, but many patients can resume light work within 2 to 4 weeks, with a gradual return to full activities as advised by their healthcare provider.

Can this surgery affect my menstrual cycle?

Surgery may lead to temporary changes in menstrual cycles; some patients experience lighter periods or altered timing initially.

Is physical activity restricted after surgery?

Yes, patients are usually advised to avoid strenuous activities and heavy lifting for several weeks to promote healing.

Will I have visible scars after laparoscopic surgery?

Laparoscopic surgery involves small incisions, resulting in minimal scarring that often fades over time.

Can endometriosis recur after surgery?

While surgery reduces symptoms, there is a possibility of recurrence; ongoing medical management may be recommended to mitigate this risk.

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