Laparoscopic surgery for endometriosis

Summary

Endometriosis is a condition in which tissue like the lining of the womb grows outside it — on the lining of the pelvis, the ovaries, the tubes, and sometimes the bowel or bladder. It causes pain and can affect fertility. Laparoscopic surgery is the only way to see it directly and, in the same operation, to remove it.

• About 10% of young women have endometriosis; it is a common cause of severe period pain and of difficulty in conceiving, and when mild it causes no symptoms at all.
• Surgery is done through small cuts under general anaesthetic; how long it takes depends entirely on how extensive the disease is.
• Deposits are excised (cut out) or ablated, adhesions are divided, and ovarian endometriosis cysts (endometriomas) are removed.
• Most women get real improvement in pain, and treating endometriosis can improve the chance of natural pregnancy.
• Endometriosis can come back. Surgery is often combined with medical treatment afterwards, and the plan depends on whether you are trying to conceive.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

A thin camera (laparoscope) is passed through a 1 cm cut at the navel and the surgeon works with fine instruments through two further cuts of just 5 mm, watching a magnified view on a screen. Every surface of the pelvis is inspected systematically, because endometriosis can be subtle and easily missed.

What is then done depends on what is found:

• Excision — the deposits are cut out, removing the disease with a margin of healthy tissue. This is generally preferred for deeper disease and gives tissue for laboratory confirmation.
• Ablation — superficial deposits are destroyed with heat or energy where excision would risk nearby structures.
• Adhesiolysis — the sticky bands (adhesions) that bind the ovaries, tubes, womb and bowel together are divided, freeing the organs into their normal positions.
• Ovarian cystectomy — an endometriosis cyst on the ovary (a "chocolate cyst") is removed, preserving the ovary; because keyhole surgery causes so much less injury, these cysts are no longer removed by open surgery. See our ovarian cystectomy guide.
• Deep disease involving the bowel, bladder or ureters needs advanced surgery, and is operated on with a combined team; this is planned in advance, not decided during the operation.

These operations are performed using 3D and 4K laparoscopy, which gives true depth perception — an advantage in endometriosis surgery, where recognising the edge of disease against normal tissue is the whole difficulty.

Why it is performed

• Pain that has not responded to medical treatment — severe period pain, pelvic pain between periods, pain during intercourse, or pain on passing urine or opening the bowels during periods
• Difficulty in conceiving where endometriosis is suspected or has been found — removing disease and freeing adhesions can improve the chance of natural pregnancy
• An ovarian endometrioma causing pain, growing, or interfering with fertility treatment
• To confirm the diagnosis — a scan can show a chocolate cyst, but endometriosis itself is diagnosed accurately only by laparoscopy: a camera passed through a 1 cm cut lets the surgeon see the deposits and the damage they have caused. Deposits can be treated in the same sitting if you have consented in advance

Endometriosis is often diagnosed years late because severe period pain is dismissed as normal. If your periods stop you doing ordinary things, that is a reason to be assessed.

Benefits

• Pain improves for most women after the disease is removed — often substantially, and for years in many cases.
• A definite diagnosis, with the extent and stage recorded, so future decisions are based on what is actually there rather than on guesswork.
• Better prospects for pregnancy — repeated bleeding from the deposits sticks the tubes, ovaries and bowel together, so the egg cannot reach the tube. Clearing the disease and freeing those structures restores that pathway, improving natural fertility and making fertility treatment more straightforward.
• Diagnosis and treatment in one anaesthetic, avoiding a second operation.
• Keyhole surgery itself: small cuts, less pain, a short stay and a faster return to normal life than open surgery.

Alternatives

• Pain relief — anti-inflammatory painkillers taken properly around your period help many women considerably, but they give only temporary relief and are not a solution if you are hoping to conceive.
• Hormonal treatment — the combined pill (sometimes taken continuously), progestogens, or the hormonal coil, all of which suppress the disease and reduce pain. These are usually tried first.
• GnRH treatment — stronger hormonal suppression, used for a limited period, sometimes before surgery.
• Fertility treatment — where conceiving is the priority, IVF may be recommended instead of, or as well as, surgery.
• Hysterectomy with removal of the ovaries — the one treatment that cures the disease completely, considered only for severe disease that has not responded to anything else, and only for women not planning a further pregnancy; see our laparoscopic hysterectomy guide.

Hormonal treatments control endometriosis while you take them but do not remove it, and they cannot be used while you are trying to conceive — which is why surgery is often the better option for women wanting a pregnancy.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure, a review of your scans, and a review of your medicines and general health. Tell the team about all medicines you take and any previous surgery or anaesthetic problems.

• Imaging first: a detailed scan (and sometimes MRI) is done beforehand to look for deep disease involving the bowel or bladder, so that the right operation and the right team are planned in advance.
• Bowel preparation: used only when deep disease near the bowel is suspected — you will then be asked to take a bowel preparation.
• Smoking: stopping even a few weeks before surgery reduces chest and wound complications.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange for someone to take you home, and plan a quiet week afterwards.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form. For endometriosis surgery the important part of that conversation is how much should be treated in one operation: whether deposits should be excised where found, whether an ovarian cyst should be removed, and what should happen if the disease turns out to be deeper or more extensive than the scans suggested. Recording your wishes now avoids a second anaesthetic. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. The abdomen is gently inflated with carbon dioxide gas to create working space, and the laparoscope and instruments are introduced through the small cuts.

The surgeon inspects the whole pelvis in a set order — the womb, both ovaries and tubes, the pouch behind the womb, the pelvic side walls, the bladder and the bowel surfaces — and records the findings and their stage, usually with images or video for your file. Deposits are then excised or ablated, adhesions are divided so the ovaries and tubes move freely again, and any endometrioma is removed within a retrieval bag. Where a deposit sits on the bowel, bladder or a ureter, it is dealt with only as far as is safe and as agreed with you beforehand. At the end the pelvis is washed out, the gas is let out, and the cuts are closed with dissolvable stitches.

How long this takes depends entirely on the extent of the disease — from under an hour for limited disease to several hours for severe, deeply infiltrating endometriosis. Occasionally, if keyhole surgery proves unsafe to continue, the surgeon completes the operation through a larger cut for your safety. This is uncommon.

After the operation

You will wake in the recovery room. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own; walking about helps.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed. Deep or extensive surgery is more uncomfortable in the first days than a limited procedure.
• Eating and drinking: usually the same day, starting with fluids.
• Moving: you can usually be up and about the same day — early walking speeds recovery and protects against clots.
• Going home: usually the day after surgery, following a night in hospital.
• Bleeding: light vaginal bleeding or spotting for a few days is normal.
• Before you leave the surgeon explains what was found and what was done — ask for this in plain terms, and ask what stage of disease was recorded.

Recovery at home

• First week: tiredness and mild cramping are normal; gentle activity and short walks are good for you.
• Week 2 onwards: most women are back to normal activity and routine work; after extensive surgery this takes longer.
• Driving: usually after about 2 weeks — when you can brake hard without hesitation. Check your insurer's policy.
• Intercourse: once any bleeding has stopped and you feel comfortable, usually after a couple of weeks.
• Your first period after surgery can still be painful; the benefit is usually clearer over the following two or three cycles.
• Trying to conceive: if pregnancy is the goal, start trying as soon as your consultant advises — the window just after surgery (or just after the hormonal course that follows it) is the most fertile period, and deposits can regrow.
• Follow-up: keep the appointment where findings, laboratory results and the plan for afterwards are discussed.

These are typical figures for keyhole surgery; your own advice may differ and comes first.

Results and recurrence

• Pain: most women improve, and many are much better for years. A minority get little benefit, particularly where pain has become long-standing and involves the nerves and muscles of the pelvis as well as the disease itself.
• Fertility: removing disease and adhesions can improve the chance of conceiving naturally. It is not a guarantee, and other factors matter too — which is why fertility is assessed as a whole.
• Recurrence: after a successful operation the disease usually stays away for two to three years, but endometriosis is a long-term condition and can return; some women need further treatment or another operation later.
• Hormonal treatment after surgery — where the aim is fertility, a course of hormonal treatment is often given to stop the periods for three to nine months, so that any remaining deposits are starved of the hormones that feed them and die back. If started, taking it continuously for the full nine months matters. The combined pill, progesterone, or GnRH analogue injections are used; side effects are usually minimal.
• Menopause: the disease is driven by hormones and usually settles after the menopause.

Risks and complications

Every operation carries risk. Endometriosis surgery carries a little more than a straightforward diagnostic laparoscopy, because the disease distorts the anatomy and sits close to the bowel, bladder and ureters. The figures below are averages from published UK guidance; your individual risk depends on the extent of your disease and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first days; shoulder-tip pain from the gas
• Light vaginal bleeding or spotting
• Bruising around the small cuts

Complications

• Injury to the bowel, bladder or ureters — the main serious risk, higher where disease is deep or adhesions are dense; recognised injuries are repaired, occasionally needing a larger cut or, very rarely, a temporary stoma if the bowel is involved (rare).
• Bleeding during or after surgery; a transfusion is uncommon.
• Infection — of the urine, chest or wounds (uncommon).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Loss of ovarian reserve when an endometrioma is removed — some healthy ovarian tissue is inevitably taken with the cyst wall; important if you are planning a pregnancy.
• Incomplete removal — disease very close to vital structures may be left deliberately, because removing it would be more dangerous than leaving it.
• Pain that does not improve, or returns later — see the results section above.
• New adhesions forming after surgery, which can themselves cause pain.
• Conversion to open surgery during the operation, for safety (uncommon).
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Worsening abdominal pain not controlled by your painkillers
• Fever (38 °C or higher) or feeling increasingly unwell
• Heavy vaginal bleeding, or foul-smelling discharge
• A wound that becomes red, swollen, hot or leaks fluid
• Burning on passing urine, or being unable to pass urine
• Persistent vomiting, a swollen tense abdomen, or not opening your bowels at all
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand how extensive your disease is thought to be, how much will be treated in one operation, and what the realistic gain is for your pain or your fertility. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Endometriosis: diagnosis and management. NICE guideline NG73. Available from: https://www.nice.org.uk/guidance/ng73 [last checked 28 July 2026].
2. European Society of Human Reproduction and Embryology. ESHRE guideline: endometriosis. Available from: https://www.eshre.eu/Guidelines-and-Legal [last checked 28 July 2026].
3. Royal College of Obstetricians and Gynaecologists. Patient information — browse all. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 28 July 2026].
4. National Health Service (UK). Endometriosis. Available from: https://www.nhs.uk/conditions/endometriosis/ [last checked 28 July 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Endometriosis: symptoms, diagnosis and treatment. Available from: https://sugabi.lk/blog/321/…
2. vog.lk — එන්ඩොමෙට්‍රියෝසිස් රෝග තත්ත්වය සඳහා සිදු කරන ශල්‍යකර්ම (Sinhala). Available from: https://vog.lk/1016-laparoscopy-endometriosis.php
3. vog.lk — යටි බඩේ වේදනාවට, දරුඵල පමාවීමට හේතුව එන්ඩොමෙට්‍රියෝසිස් ද? (Sinhala, by Dr Chaminda Mathota). Available from: https://vog.lk/623-endometriosis.php
4. vog.lk — වඩාත් ආරක්ෂිත ලැපරොස්කොපි සැත්කමක් සඳහා 3D ලැපරොස්කොපි තාක්ෂණය (Sinhala, by Dr Chaminda Mathota). Available from: https://vog.lk/1040-3D-4K-Laparoscopy.php
5. vog.lk — ලැපරොස්කොපි සැත්කම් සිදු කරන හැටි (Sinhala). Available from: https://vog.lk/735-laparoscopic_surgery.php