The Expert: Dr. Marc Even, gynaecologist
Endometriosis is a pathology that affects more than two million women in France. It generates Pains and various symptoms that can be debilitating on a daily basis. Some women therefore opt for surgery to remove the lesions caused by the disease, especially in cases ofsevere endometriosis. What is the coverage for this operation? The explanations of Dr. Marc Even, gynaecologist.
What is endometriosis? The definition
Endometriosis is a fairly common female pathology. In France, according to the Ministry of Health and Solidarity, it affects almost 10% of women of childbearing age. This is the diffusion of the endometrium from the uterine cavity, which then colonizes organs and tissues of the abdomen. These lesions cause pain and fatigue that can severely affect the quality of life of these women and even prevent them from starting. pregnancy.
Does endometriosis work?
Some patients manage to regulate the effects of the disease with medical care, treatments, and a pill, often in conjunction with a holistic approachwith dietetics, sport, relaxation… “In cases where this treatment of the disease fails, the patient is offered surgery, particularly in severe endometriosis. It’s never a first-line approach.” explains Dr. Marc Even.
Digestive, deep, ovarian endometriosis… How to recognize it?
The operation takes place under general anesthesia. And depending on the type of endometriosis the patient is suffering from, the treatment is multidisciplinary. “The surgeon has the choice to perform an operation under laparoscopyor robot-assisted laparoscopysometimes to multiple practitioners, depending on the localization of lesions », says dr Even. To do this, the patient must undergo various examinations before her procedure, such as an ultrasound and a pelvic MRI, so that specialists can localize the endometriosis foci. These can affect the digestive tract, the diaphragm, fallopian tubesthe uterosacral ligaments… “Questioning the patient also helps us a lot, if she mentions diarrhea or abdominal pain during her period, for example, we aim more towards digestive endometriosis,” adds the gynecologist.
What surgery for endometriosis? Should an endometriotic cyst be operated on?
It all depends on where the endometriosis is located. The technique of surgery for endometriosis of the digestive tract is le “to shave”which means “to shave” in English. “The lesions are shaved, then they are coagulated to prevent bleeding,” describes the surgeon. In the case of deep endometriosis, the patient is hospitalized in the meantime 2 and 5 days approximately. In the case of ovarian endometriosis, it will be the removal of the cysts. This type of surgery can be done on an outpatient basis.
Surgery for endometriomas or cysts caused by endometriosis on the ovary can be performed in four different ways.
It consists in removing the cyst and its fibrous wall. In this type of surgery, the surgeon also removes part of the ovarian tissuewith the result that the ovarian reserve of the patient is reduced.
ablation or vaporization
This surgical gesture is for direct destruction the cyst. This technique is performed with laser or plasma, avoiding the destruction of the underlying ovarian tissue.
sclerotherapy or alcoholism
95° alcohol is instilled into the cyst, which destroys it after 10 to 15 minutes without damaging the ovary.
Puncture-aspiration or drainage of the cyst(s)
It is performed on a patient with an already limited ovarian reserve and, with a certain risk of recurrence, is reserved for women who start in vitro fertilization immediately. The purpose of the gesture is then for relief oocyte collection.
In any case, the type of intervention is decided on the basis of the patient’s profile, her medical history, the course of the disease and her desire to become pregnant.
What are the chances of a cure for endometriosis? Is surgical treatment effective?
After an operation for endometriosis, the patient’s condition can improve if she starts taking immediately afterwards a pill constant. This will block her period and prevent new lesions from forming, limiting the risk of recurrence. “ But as part of a desire for pregnancythe pill is not possible because there is one block ovulation. It is therefore important to offer surgery at an appropriate time in the patient’s life.” closes the specialist.
Endometriosis and pregnancy: is it possible?
The purpose of surgery for endometriosis is to remove the lesions affecting the organs of the abdomen, sometimes numerous in severe endometriosis. “The ideal is to only use them once. There can be very good results, and even promote the fertility of these women. I will take the example of a 28-year-old young woman whose endometriosis pain cannot be relieved and whose lesions have been localized to an ovary. After removing this cyst, she was able to become pregnant. This happens in 30-40% of cases. describes dr. Marc Even. “This is not the primary goal of surgery, but rather pain relief and avoiding the risk of recurrence, but 30% of women Sufferers of endometriosis also suffer from infertility, so if it can give them anything thrust… But beware, for ovarian endometriosis, repeated surgeries can alter ovarian reserve. That’s why I say it’s better to operate on them just once.”