Laparoscopy Surgery for Endometriosis

A few weeks ago, I received a request to share more about the laparoscopy I had in January.  When I was preparing for surgery, I searched the internet for blog posts about the procedure so I could get an accurate picture of what recovery would be like (and line up appropriate help). So I figured it might be useful if I shared my experiences as a blog post so that others could read it as well.

My surgery:
My laparoscopy was scheduled as an exploratory surgery.  My cycles didn't show much in the way of endometriosis symptoms, but since I had had recurrent pregnancy loss that didn't seem to have other explanations (I did have low progesterone but was on progesterone shots for two of my pregnancies and still miscarried), my doctor thought there was a good chance that I did indeed have endometriosis. According to the NaPro Technology website, "In women with repetitive miscarriage, 85% will have endometriosis." The link between miscarriage and endometriosis hasn't been well researched, but it's suggested that the endometriosis causes inflammation, which interferes with implantation. Anyway, since we were running out of testing options, the laparoscopy was really our next step. (UPDATE: This topic seems to finally be getting some attention! A recent study in Scotland showed that "women with endometriosis are at an increased risk of miscarriage and ectopic pregnancy. The research further found that women with a history of endometriosis whose pregnancies progressed beyond 24 weeks were found to be at a higher than average risk of complications, including hemorrhage (ante- and postpartum) and preterm birth.")

In addition to the laparoscopy, I was also scheduled for a hysteroscopy (a scope is inserted up the vagina to look at cervix and inside of the uterus) to check for scarring, polyps or other irregularities inside my uterus and for dye to be pushed through my fallopian tubes to clear them if they were blocked (I don't think it was actually a hysterosalpingogram since I don't think that x-rays were taken during the process, but maybe they were?). My fallopian tubes were clear and my uterus looked perfectly normal.

Because it was an exploratory surgery, I didn't know what to expect going in since I wasn't sure what would be found. My doctor planned to remove any endometriosis that he saw so the length of the surgery (and recovery) would depend on the extent of endometriosis present. If none was found, I would only have one small incision in my belly button. As it turns out, I did have extensive endometriosis, which caused some of my organs to adhere to one another, and an endometrioma (a cyst of endometrial tissue) on one ovary. I ended up with three incision, one in my belly button and one on each side close to my hip bones. Each is less than a half inch long. The surgery took about 2 hours.

What exactly is a laparoscopy?
I realized after my surgery that most of my family and friends didn't realize exactly what happened during my surgery. They seemed to think that the endometriosis was removed from the inside of my uterus. That is not the case. Endometrial tissue is supposed to be on the inside of the uterus. During a woman's cycle, the endometrium in her uterus builds up, providing, in essence, a cushion in which a fertilized egg can implant. If no pregnancy occurs, the endometrium leaves the body (menstruation). This is normal and healthy. Endometriosis occurs when endometrial tissue is located outside of the uterus (the reason why this occurs is still unknown, though there are a few theories) on various organs and ligaments in the abdominal cavity, which often causes them to adhere together.

Therefore, surgery to look for/remove endometriosis occurs outside the uterus in the abdominal cavity. A small incision is made in the abdomen and a scope is inserted to look around the abdominal cavity. If endometriosis (or anything else) is found and needs to be removed, it's usually done through that small incision and/or a few others, though sometimes bigger incisions are necessary. Gas is pumped into the abdominal cavity so that the doctor has space to look at the organs and perform the necessary excision/cauterization of endometrial tissue.

Preparation:
Here are a few of the things that I did to prepare for surgery that I would suggest someone else does --

• Lined up someone to care for my daughter during the surgery and afterward. A family friend took care of Lucia the day of the surgery and my mom flew out the next day to stay with us for a week. If my mom didn't come out, it would have been nice to have a meal train set up in addition to child care for Lucia for the following week. (Or a house stocked full of easy to make items, like yogurts, soups I just had to heat up, and takeout menus.) I probably could have survived alone with Lucia after the first four or five days or so, but having a full week and a half of rest made sure that I didn't overdo it. And, from what I've read, recovery can vary widely, so it was quite possible that my recovery could have been slower. Having help lined up for longer than needed is much less of a problem than not having help for long enough.
• Had Gas-X and a heating pad at the ready. Before my surgery, I repeatedly read that the main source of pain after a laparoscopy was not the incisions but the gas that was pumped into the abdominal cavity. This gas usually collects in the shoulders and neck when you sit/stand and can be very uncomfortable. A heating pad and Gas-X are said to help. I didn't actually have much of this pain (my doctor said he was able to get most of the gas out after the procedure) but I was glad I had these on hand just in case and did use them minimally the first few days.
• Made sure I had an appropriate wardrobe. Because of the gas (ie bloating) and location of incisions, wearing jeans isn't comfortable for a while. I was able to fit into regular jeans pretty quickly (other women reported it being a few weeks until bloating went down), but the waist band rubbed against my sore incisions. Skirts and pants with stretchy/jersey waistbands were necessary for the first 1-2 weeks for me. I went through the clothes I had to make sure I had at least a few options to wear. I did, but had that not been the case, I would have shopped some thrift stores so get enough bottoms to last me between laundry loads.
• Prepared things to do while recovering. It was hard to read the first few days because of the pain medication, so I knitted and watched some Netflix shows I'd been wanting to watch but saved up specifically for after surgery. My sister-in-law sent me a few new books I'd been wanting to read, so that was helpful to pass the time after the first few days. You are supposed to get up and walk around to help you heal, so you're not on bed rest, but I was very tired and in bed resting much more than usual. 
• Followed the hospital rules. I'm sure this goes without saying, but I followed the directions given to me at my pre-op appointment to a T. Not just the obvious things like no food or drink after midnight (if I had to do it again, I would have had several glasses of water the night before because I felt SO dehydrated all morning before my surgery), but also the light meal the night before, etc. 

Recovery:
When I read other blog posts and asked other women who'd had this surgery about their recovery time, I found a wide range from from only a few days to six weeks. Mine fell on the shorter end. It took me a good two weeks to feel 90% and about a month before I was back to 100%, but after about 4 days, the initial pain and weakness was gone. (As someone mentioned, I conceived less than two weeks after the surgery, so recovery couldn't have been too awful.) I had the surgery on a Friday and was back to caring for Lucia single-handedly during the day on the Monday a week and a half later. I would have loved a few extra days of rest during the day because I was still tired and moved a bit slow, but I survived just fine. I wouldn't suggest someone go back to a physical job that quickly, but a desk job I could have managed.

I only needed the prescription pain medication for two days after the surgery, then I switched to over-the-counter ibuprofen. I only took that for a few more days as needed (not all day long) and stopped taking any pain medication about 4 days after the surgery. After that point, most of the pain was related to quick abdominal movements (like sitting up in bed quickly, forgetting that I had just had surgery - ouch) or accidentally bumping my incisions.

Trying Again:
Though not everyone has endometriosis removed to conceive, many do, so I thought I would mention this piece real quick. My doctor usually does laparoscopies during the first half of his patients' cycles so that they can start trying to conceive the very same cycle. Other women I talked to said their doctors told them to wait 1-2 full cycles after their surgery before trying to conceive. So there isn't a set amount of time. My doctor encourages trying right away because endometriosis often returns so the chances of conceiving may decrease over time as the endometriosis returns and spreads.

Of course, regardless of what my doctor said, it was up to David and me to make our own decision about how long we wanted to wait. The surgery didn't delay ovulation like I figured it would  (it did affect my mucus buildup, but peak was on the same day it is almost every cycle), so I actually ovulated much closer to the surgery than I expected. Since I was feeling up to *ahem* relations, we decided to try right away, in part because it usually took us several months to get pregnant. Apparently, with the endometriosis gone, we get pregnant much quicker because we conceived right away, which we did not expect at all. (Though it makes sense - after my surgery, my doctor said he was surprised I'd been able to get pregnant at all in the past few years because of the extent of the endometriosis.) Thankfully, I already felt fully recovered from the surgery by the time I got a positive pregnancy test and before I had any pregnancy symptoms.


Anything I didn't cover that you'd like to ask about? Feel free to ask questions. If you'd like them to be anonymous, feel free to email me. And if you do comment here, MAKE SURE YOUR ACCOUNT IS LINKED TO YOUR EMAIL ADDRESS so I can reply directly to you, especially if I don't feel comfortable answering a specific question in a public manner.