Should I have a second laproscopy??

[Spanna]

Girls, this might be a silly thing to say but I'm questioning if I'm in enough pain to have a second lap?!?!

I had my first in 2009 to remove choc cysts and severe endo. After fertility treatment I was lucky enough to conceive my daughter in 2010 (she was born may 2011). I have been 'relatively' pain free since then up until around 4 months ago when it came back with a vengeance.

My doc is an and has said she will operate again if I want her too but I'm struggling with a few things - the pain isn't unbearable ALL of the time, it's always there and exercise / walking / certain sitting positions makes it worse but I'm not popping pills all the time. And also it's a different pain to last time. Before it was horrendous when I was on my period but not all the time but now I'm not having periods (i have the merina coil) and the pain is everyday just different severities.

My husband hates seeing me in pain and is pushing for the lap but I'm just not sure.

Any opinions / similar stories would be gratefully received :o) xx

[cupcake40]

Hi, I was actually diagnosed with severe endo in 1997. I had my first lap in 1997, second in 1998 and have had all types of hormone treatments, various tablets over years, synarel spray for 6 months depo provera for 5 years. We eventually had our son in 2000. In 2009 I had a endometrial thermo ablation and six months later I had the mirena coil in. I am exactly the same as you with unbearable pain at times but not all the time. For the last two months apart form the nasty dull ache in pelvis, hips, back, thighs I have also had very sharp spiky pains which is completely new to me. I went to see the Consultant 2 weeks ago who wants to do another laparoscopy to remove endo again and adenomyosis. I have been left to decide if I want this degree of intervention or to try pain management but I have to take co-codamol to get any relief. I can only take at night as they make me sleepy and I work full time. For the last two years I have suffered with panic attacks and health anxiety and find it difficult to go near the hospital. The thought of another general anaesthetic scares me but I need to get on with my life and don't know what to do. Common sense tells me I need to know what is going on inside but am too scared. Wish it could all be seen on scans. I know I haven't helped you with your dilemma but at least you know you are not on your own.

[Spanna]

Thanks for your reply cupcake. Bless you, it sounds like you are having a horrible time too.

I cleaned the bathroom today.....now. Can barely move. I'm getting nearer to making the phone call to my gynae I think ??

[roann]

sorry to hear what you are going through but u should know that you are not alone. i did a lap in 2011 and now 2 yrs after actually it started a year after the pains are worst..i am debating if i should do another lap too my doc said its the only thing that can be done since the pulls don't help with the pain..i even want to remove my ovaries. i am 21 and have no kids but would really like to have one..so i am now left with a lot of tough choices to make..i cry every night because of the pain and because i really don't know what else to do. just like you i feel a lot of pain when i do certain work and when i position myself in a certain way. i get major cramps sometimes its difficult for me to hold anything. i really do hope that u will make a decision soon so that you can be out of all that pain..whatever you choose to do i wish you all the luck.

[stevieflp]

The thing with laps is this is just the term used for the op which simply means keyhole entry and insertion of a laparoscope as opposed to open surgery. The outcome of the op will then all depend upon what is done once the surgeon is inside. That will also depend upon the experience and extertise/specialism of your surgeon. Sometimes they just have a look around, sometimes they do some laser work, sometimes they remove some patches of endo and then there is total radical excision of endo. It will all depend upon what the surgeon actually did as to the outcome of your lap and the relief from endo that you will or will not have gained. Excision surgery is known to be more effective than laser. Obviously the degree of endo that you have will require different degrees of surgery so it is important that these two match. Laser for very advanced widespread endo would be an inappropriate as total radical excision would be for minor patchy endo.

My consultant explained it in gardening terms as my other half is a gardener :). He said:

Laser treatment is much quicker for a surgeon to learn than excision surgery (hence it is generally carried out not by an endo specialist as they prefer excision). Laser burns off the top layer and forms scar tissue as a result. However, more often than not, endo can remain at the deeper level (like cutting down a weed and leaving the root) and so over time it does sometimes reappear, but in a different patch because of the scar tissue formed above. I have seen posts where a surgeon who has carried out laser work has said "oh it can't be the endo back as I removed it".

Commonly more experienced gynaes / endo consultants will carry out excision surgery - this tends to be 'patch' excision which does what it says on the tin. This is fine if you do just have patches. However, endo can be unseen to the naked eye and so ladies sometimes will end up going back for further patches to be removed later but it can give medium-term relief if the right patches that were causing the pain are removed.

Then there is 'total radical excision'. This is all keyhole and the whole lining of the peritonium is stripped out in one hit (takes between 5 - 8 hours) but it does remove seen and unseen endo and when it heals, leaves you with a clear abdomen (well as far as possible). It also unfreezes organs that have become stuck together - but it does need to be undertaken by a specialist endo consultant and, unfortunately, too few can do this. Whether that is due to lack of skill or whether they just do not want to undertake such long ops - who knows. That is not to say that endo will not recurr at some point but there is a better chance of keeping it at bay with less chance of multiple ops over the longer-term.

Thought it might help you to see what the surgical options generally offered are and they all come under the umbrella of a 'lap'.

All very best wishes x