Without a laparoscopy
- the diagnosis is only a suspicion of superficial endometriosis, except when a cystic ovarian endometriosis was diagnosed by ultrasound
- If pain started suddenly, endometriosis is unlikely. A cystic corpus luteum needs to be excluded.
- If a BIG deep endometriosis nodule is diagnosed by clinical exam or ultrasound (MRI), the diagnosis is probably correct; for smaller lesions, the risk of false positives and of false negatives is high
- If the type of endometriosis was not explained, your gynaecologist is probably not a specialist
If laparoscopy is planned, then check the planning
- A cystic ovarian endometriosis of more than 6 cm needs surgery in 2 steps otherwise, the ovary risks being destroyed.
- For large deep endometriosis, hydronephrosis (e.g. with ultrasound) and bowel stenosis (with a contrast enema) need to be excluded
- A ureter stent is indicated only in cases of hydronephrosis
although many surgeons continue to use stents in all women with deep endo.
- Check the expertise of the surgeon and his percentage of bowel resections. Bowel resection are rarely needed (<5%) and should be decided during surgery. .
If surgery was not performed during laparoscopy
- This should have been agreed in the informed consent to prevent medicolegal problems
- Check the photo’s or video to ascertain what has been checked: e.g. the appendix, the sigmoid and diaphragm. Without video-registration it will remain unclear.
If surgery was performed, you should
- check video registration to know
- which type of intervention you had
- was the excision complete or incomplete.
- duration of surgery?
Medical treatment was given without a laparoscopy
- this can be done occasionally, not as a preparation for surgery
- this can be given for a short period to evaluate the effect on pain
- for a longer period without a diagnosis is generally a mistake