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| Endometriosis-2 |
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1. Medical (drug) treatment:
Especially used to relieve pain. Contraception pills, GnRH analogues, drugs like danazole progestines having hormonal effects are used. With the use of these drugs, suppression of the endometriosis focuses and pain relieving is aimed. However, endometriosis focuses can not be completely removed with drugs and also patients can benefit from drug therapy limitedly. The most effective drugs among these are injections called GnRH analogues. With the affect of GnRH analogues, pituitary gland and therefore ovaries are suppressed and “pseudo-menopause” is created. Since endometriosis focuses develop under the affect of hormones, these focuses regress and pain is relieved due to the suppression of the ovarian hormones. These drugs are generally used before the operation or after the operation with periods of 3-6 months. They are in the form of injections administered monthly with intervals of 3 months. Due to their adverse effects, they are not recommended to be used more than 6 months. Contraception pills or progestines can be used for a longer period. Complaints generally rise again after the drug therapy. Today, it is found that drug therapy has no benefit in infertility. These drugs do not have an affect on conceiving and lead to a waste of time. 2. Surgical treatment: The treatment method having priority with the presence of pain due to endometriosis, chocolate cyst and infertility is surgical approach. For each patient that surgical treatment is possible, laparoscopic surgery should be the choice. If laparoscopy can not be performed or the surgeon is not experienced enough, then endometriosis treatment with open surgery can be done. Laparoscopic surgery has many advantages compared to the classical open surgery. Especially for patients who would like to have baby in the future, laparoscopic surgery should be performed with experienced teams. The purpose for the surgical treatment of endometriosis is to destroy or demolish endometriosis focuses as much as possible, to abolish adhesions, to remove chocolate cyst (endometrioma) from ovaries if present and to restore the deteriorating anatomy. In order to destroy the endometriosis focuses, electric energy or laser is used. Laser has a significant superiority compared to other methods especially in the presence of widespread endometriosis. To abolish adhesions in the abdomen and between the genital organs and to prevent from forming again, necessary steps should be taken. In laparoscopic surgery, various surgical techniques are used for the treatment of chocolate cysts. However, the most effective treatment method is cystectomy (removal of the cyst completely). In the situations like only aspiration of the cyst in laparoscopy (removing the liquid inside), burning the wall of the cyst without removing it, or removing it incompletely, the risk of reformation within 6 months-1 year increases significantly. After a successful surgical treatment, the probability of repetition is very low. If the patient has no complaints, it is recommended to follow the cysts smaller than 3 cm, and remove them if they start to enlarge. The drug treatment of chocolate cysts is unsuccessful. Drugs are only used to shrink the cyst before the surgery and facilitate the operation or to relieve pain in the post-operational period.
 The execution of laparoscopic surgery can be seen.
While chocolate cyst is being removed, it is very essential to preserve the intact ovarian tissue. Especially for young patients, or patients willing to have children in the future, since removing the intact ovarian tissue with the cyst or removing the complete ovary containing cyst is unnecessary and wrong, this should be avoided. If not, the ovary reserve and fertility potential of a woman decreases and also early menopause can form. Today, for some selected patients, drug treatment is used as a complementary therapy to surgery before the operation to shrink the chocolate cysts or for periods of 3-6 months after the operation.
With the definition of chronic pelvic pain, pains continuing for more than 6 months should be understood. For women who have severe groin pain and lumbago, severe pain during menstruation or painful sexual intercourse, addional processes directed to ease the pain are also performed during laparoscopy. With laparoscopic LUNA (laparoscopic uterine nerve ablation) or presacral nerve ablation, nerve ends transmitting the pain stimuli are destroyed. After these processes pain is significantly relieved.
For infertility patients, the chance to conceive is most probable within the first year following the operation. For patients who can not conceive within the first year following the operation, other treatment options should be offered. During laparoscopy all reasons leading to infertility should be abolished. Destroying the endometriosis focuses using laser, abolishing adhesions, if present, and making tubes penetrable, removing chocolate cysts (endometrioma) if present in the ovaries and restoring the anatomy should be performed. For women who would like to conceive, if this can not happen within first year after the operation, then other infertility treatments should be executed. If the spouse has sperm problems, then the selection of the treatment may differ.
Factors affecting post-operational success:
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