Post-operative pain following endometriosis surgery
Surgery for deep infiltrating endometriosis is one of the most complex laparoscopic operations.
As I often tell my patients, these surgeries are sometimes a major “injury” to the body, a major physical trauma. This is due to the extensive dissection that must be performed in a narrow space (pelvic space), a ‘crowded place’ of visceral structures (internal genital organs, rectum, bladder, ureters), vessels and nerve fibers.
During these interventions organs are pulled, sometimes damaged, nerve fibres may be sectioned during the excision of the endometriosis lesions, meaning that sometimes the patient can have intense pain after surgery. Immediate post surgery pain is often treated with analgesics, anti-inflammatory medication prescribed by the anaesthesiologist in the intensive care unit.
Sometimes (I recently had such a case), due to chronic years of pelvic pain, patients being neglected/ignored by gynecologists/doctors who are not endometriosis specialists, the pain might be centralized, which means that even after proper excision, the patient may have approximately the same pain intensity. Something similar with the amputated limb syndrome (patients experience pelvic limb pain that no longer exists).
Postoperative pain depends on the complexity of the surgery, the extent of the disease, as well as the patient’s ability to handle pain. So for example, a patient who had a surgery that lasted a couple of hours (minima/superficial disease) might have a higher post op pain than a patient who had a complex surgery that lasted 7-8 hours.
Also postoperative pain such as late pain, at least 2-3 weeks after surgery by the appearance of postoperative adhesions.
I am often asked what we can do to prevent surgery adhesions. Sometimes, when endometriosis is extremely extensive, postoperative adhesions are the rule of postoperative healing. This is due to extensive peritoneal excision, which causes the organs to adhere to each other.
The postoperative adhesions should NOT be confused with the adhesions caused by the disease itself (fibrotic endometriosis lesions).
Prevention of postoperative adhesions can be done by having a correct surgical technique, avoiding intra and postoperative bleeding, limiting dissection (difficult to achieve in extensive deep endometriosis), ‘washing’ the peritoneal cavity with special substances, anti-inflammatory medication and sometimes the use of products based on hyaluronic acid (which has not yet been scientifically proven to be effective).