Endometriosis – Rectovaginal Diseases :
Performed for Infertility or severe pain in lower abdomen during menstrual period and painful sexual relations or pain during defecation during period.
Dysmenorrohea, Dysparenunia & pelvic pain & Pain during defecation and Infertility are the presenting symptoms. Endometriosis is the commonest cause of Infertility during Laparoscopy. Pigmented & white fibrotic lesions are the two different varieties of lesions. Endometriosis is poorly detected during laparoscopy leads to more than 2-3 laparoscopy of infertility patient without result. Endometriosis needs to better address during laparoscopy, as residual diseases leads to recurrence & Infertility. Lot of awareness needs to be generated among Gynecologists for its identification during Laparoscopy, right treatment & documentation during surgery, proper post operative aggressive fertility treatment within nine months as it may reoccur after nine months & follow up. Most rewarding results were achieved following laparoscopic surgery with pregnancy rate from 50 to 70% in different series in mild, moderate to severe Endometriosis.Cystectomy should be preffered over simple drainage for preventing reoccurrence. But if we feel that cystotomy dissection is too difficult & likely to destroy many normal ovarian follicles, we should do drainage & bipolar fulguration of internal surface of chocolate cyst. Rectovaginal endometriosis is not touched most of the time during laparoscopy. We need to learn, identify the right cleavage & proper dissection of recto-vaginal nodule for her pain relief. With increased awareness will find out more & more incidences of Endometriosis during Diagnostic laparoscopy.
Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images – and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.
Many patients undergo laparoscopy as Day care procedure, returning home within 24-48 hours of surgery. For normal laparoscopy procedure takes about 25 to 75 minutes only. For advanced Endometriosis it may take 1-2 hours. Most begin feeling much better within one day.
Routine charges are from Rs. 20,000 to 25,000/- in usual cases without complicated intervention.