Endometriosis surgery- do they cut through the abdominal muscles?

[Mary76]

Hi,

I posted a while ago already about a cyst that my doctor wants taken out, and I explained the various reasons- including previous major abdominal surgery- why I would only opt for surgery if it is completely unavoidable.

In short, I went to see a different doctor today to see what her opinion is about the cyst, and wether it needs to be taken out. The cyst was 3.8 cm today (which means it is the same size since it was discovered in February).

First of all, she said that on the ultrasound it looks like it has some solid components, and some blood. She mentioned the term "endometriosis"- what exactly is that? I have read the term before, but I don't know what it really means. She is very certain that the cycst does not look malignant, which is also unlikely (though I know it's not impossible) since I'm only 28 years old. She doesn't think that the cyst will go away on its own, because the blood looks coagulated, which precludes the disappearance through rupturing. Therefore, she strongly recommended surgery.

Now I guess I'm especially concerned about this: I read that for open surgery (a laparotomy would likely be impossible in my case, because my abdomen was cut open before and there may be "things in the way" as the doctor but it), is it necessary to actually sever the abdominal muscles?

This is absolutely terrifying to me, because I am a weightlifter and the abdominal muscles are so all-important for lifting and being strong. If they got permanently damaged, I would be absolutely devastated.

Thanks so much to anybody who can give me a little info!

Mary

[MickeyVicki]

Yes, for example, there are  doctors who specialize in removing endometriosis who use special surgical tables which allow them to tilt the patients on their sides during the surgery.  Other surgeons approach surgeries more from the view of a plastic surgeon, trying to reduce scarring and other unwanted side effects.  It might take a while to find one,  but I would think it possible to find a very competent surgeon who can help you.

[Mary76]

Hi MickeyVicki,

thanks so much for answering my questions so informatively and carefully. I had secretly been hoping that you would answer, because you always sound so smart and knowledgable :-)

Your suggestion about finding a surgeon who can still do the laparoscopy sounds very encouraging, that's something that I hadn't thought of because the doctor today just told me that I would have to let the surgeon do whatever he chose to do and I wouldn't have any influence on how the procedure would be performed. So I felt really helpless.

Thanks again!

Mary

[MickeyVicki]

Endometriosis is a condition caused when the normal menstrual blood forms as implants in other parts of the body (not inside the uterus where it belongs.)  What you  likely have is what I had  removed last year:  an endometrioma - which is a type of cyst filled with endometrial tissue.  Your doctor is correct; if you  have an endometrioma then it will not only be unlikely resolve itself, but it will likely continue to grow.  Mine not only grew larger but damaged the ovary and fallopian tube, and started attaching itself to other tissues in my abdomen.

As far the affect on your abdominal muscles, I would not be as worried about that as the fact that some studies show endometriomas can become malignant, especially if they are located on the left ovary.  Also, if the cyst grows large, and then ruptures (which it is more likely to do if you lift weights, including things like a toddler or a full laundry basket!), then you could very likely have a severe abdominal infection.  

I had four incisions last year for my laparascopic surgery to remove my endometrioma (as well as that damaged ovary and fallopian tube.)  I have to exercise my abdominal muscles to compensate for a nearly herniated umbilicus; I have done so for over 30 years now.  After I healed from the surgery and was cleared by my doctor to lift weights and do sit-ups, etc., I have not had any problems from the surgical incisions.

My suggestion is to find a surgeon who feels that he or she can still perform laparascopic surgery on  you despite your previous surgical experience, or who can perhaps open you from a lower or smaller incision site, rather than the midline laparotomy.   It is certainly worth trying to find a surgeon who can accomodate your needs before you simply write off having the surgery.