Endometriosis UK
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Lap tomorrow, need advice!

Hello, I am due to get my laparoscopy tomorrow and I have a few questions and hopefully someone can help me. I am 24 and live in Scotland. I am not one for visiting my doctor, never have been. I am at this stage now as I had an abnormal smear this time last year which then led to colposcopy, gynae consults and finally an ultrasound which found a 5cm cyst on my right ovary. Now that I am at this point and have been doing my research I am starting to realise I should have gone to gp years ago. I have always suffered from heavy painful periods, back pain, fevers, nausea and fatigue. For the past 6 weeks or so I have now been suffering with headaches, full body pain including hips and legs which keeps me awake and hurts even when walking, restlessness, stabbing pains in my right lower side which have crippled me to the floor twice now and a constant pain in my right side towards the back which feels muscular but has been there for 6 weeks now. I haven't told gp or any hospital doctor of these symptoms. I am a great supporter of our NHS and feel that I don't want to waste anyone's time (silly I know). I'm really ranting on here but I just want to know if anyone with Endo suffers from similar symptoms, as they are checking me for it tomorrow. How best to manage the pain and carry on with a normal life. I have stopped working full time and have no social life anymore, I suffer from anxiety and just like being in my house with my partner and 2 dogs lol! Will I be told the results of lap after recovery before I get discharged? Up until this point I have been messed around and not told very much, my pre op lasted a whole 8 minutes!!! I have had to find out all information myself about ovarian cysts, endo and the procedure. Any advice would be greatly appreciated x

4 Replies

It is important to tell your surgeon what symptoms you get, make a list, endo in different places can cause different symtom, so hopefully if he is aware off endo he will check all the locations that it can be in, are they going to remove the endo if found or is it just diagnoses, good luck xxx

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Firstly don't panic, you are having your lap tomorrow so you will know by tomorrow night how things stand, forget about what's in the past, it's done with. Yes they will tell you what happened in the surgery, either your consultant will come round in the afternoon if you have your surgery in the morning or they'll come round and see you the next day if you are kept in. Make sure to write everything they tell you down, maybe text it to your partner as the anaesthetic makes you a bit groggy and forgetful. Also if they give you a discharge letter for your gp make a copy of it before handing it over.

This website gives a lot of Endo info and there are pages on laparoscopy and preparing for/recovering from surgery that you should read. endo-resolved.com

Good luck, hope all goes well, you will feel a lot better when it's done.



The most important thing at this point is to do all you can to ensure you have a thorough lap. An eminent laparoscopic surgeon has described a diagnostic lap as being like looking for a coin among a pile of crumpled sheets. Every nook and cranny must be systematically examined. Endo can be missed in general gynaecology and it is important that your surgeon closely follows the guidelines for carrying out a diagnostic lap. Lararoscopy is the gold standard for diagnosis, with biopsies taken of suspicious tissue to be confirmed by histology. So this is the first point you need to confirm with him or her - that samples will be taken. Also confirm that photos will be taken of all the areas inspected.

As far as the procedure itself is concerned, this is described in the guidelines so I should take a copy with you (see extract below) and go through it with them to make sure they thoroughly search your pelvis as the guidelines require. In particular note the requirement to do a rectovaginal exam while you are under - this involves fingers up the bottom and vagina at the same time with palpation of the entire area to feel for deep nodules that aren't visible at a lap. This is critically important as so many women come away from a lap without this being done and have deep endo missed. Then request that all the various steps are recorded in the operative report.

Below is the extract from section 1.3.1of the ESHRE guidelines that underpin NHS treatment - I have put a link at the end to the publication for you to access.

'...the quality of both negative and positive laparoscopies depends highly on the abilities of the surgeon performing the laparoscopy. The experience, skill and knowledge of the surgeon determine whether endometriosis will be diagnosed if present. Retroperitoneally and vaginally localized endometriosis can be easily missed, especially if the patient has not been thoroughly examined preoperatively, preferably during anesthesia.

A good quality laparoscopy should include systematic checking of 1) the uterus and adnexa, 2) the peritoneum of ovarian fossae, vesico-uterine fold, Douglas and pararectal spaces, 3) the rectum and sigmoid (isolated sigmoid nodules), 4) the appendix and caecum and 5) the diaphragm. There should also be a speculum examination and palpation of the vagina and cervix under laparoscopic control, to check for 'buried' nodules. A good quality laparoscopy can only be performed by using at least one secondary port for a suitable grasper to clear the pelvis of obstruction from bowel loops, or fluid suction to ensure the whole pouch of Douglas is inspected.

The limited value of negative histology can also be explained partly by lack of knowledge of the clinician and/or the quality of the procedure, resulting in bad samples, squeezed samples or samples taken from the wrong location.

An appropriate preoperative clinical evaluation could prevent clinicians from overlooking deep endometriosis outside the peritoneal cavity or retroperitoneal lesions. Therefore, the GDG recommends that clinicians should assess ureter, bladder and bowel involvement by additional imaging if there is clinical suspicion of deep endometriosis, prior to further management.'



Thanks ladies. Will take all your advice on board. I have written out a list of everything that's been going on and depending on the level of care presented tomorrow I may give it to consultant or my own gp afterwards. As for whether they will treat the endo if any found I am unsure. The surgery is an investigative lap to check my cyst and for endo. They said they may remove my cyst if they feel need be. I would rather they do everything they need to while they're in there to save me going through another surgery. Although every consultant and Dr I've spoken to hasn't been the best at prompting me to talk so they don't know anything about how I'm feeling... I realise now that I need to speak out for the benefit of my health. I'm feeling very anxious about tomorrow and quite teary. I have tried to do all my housework today so I don't need to worry about it but have found myself only lasting 30 minutes at a time out of bed without feeling faint and nauseous. Only the hoovering to go after a wee lie down!! X


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