ENDOMETRIOSIS & SURGICAL CARE
If you are considering surgery, you deserve to understand what it could help with, what treatment would involve and how it fits your life and future plans.
I offer advanced laparoscopic care for endometriosis. Together we consider the likely benefits, alternatives and limits, including what to do if pain continues after treatment.
DECIDING ABOUT SURGERY
Laparoscopy uses a camera and instruments through small abdominal cuts, under general anaesthesia. It can investigate suspected endometriosis, treat agreed findings, or do both.
Surgery may help when pain continues to disrupt your life, medicines have not helped or are unsuitable, or a cyst or deep disease needs treatment. Fertility can be another reason to consider it. We agree the goal and what would count as improvement.
A normal scan does not exclude endometriosis, but surgery is not required before all treatment. Medicines, further assessment, pelvic-floor care or observation may fit your needs. Your preferences and previous experiences matter.
MY APPROACH TO YOUR CARE
I review your symptoms, imaging and previous treatment alongside your goals. My urogynaecology training helps when pelvic-floor, bladder and gynaecological concerns overlap.
For endometriosis, I work with colorectal surgeons and fertility specialists when their input is useful. Physiotherapy can help address overlapping pelvic-floor symptoms before or after surgery.
We discuss what was found and treated, any tissue results and the next step. Recovery and ongoing symptom care form part of the plan.
WHAT TREATMENT MAY INVOLVE
I plan treatment around the sites involved, your symptoms and the need to protect nearby organs and healthy ovarian tissue. Different findings may need different techniques.
BEFORE YOU DECIDE
We review scans and previous operation or tissue reports. Suspected deep disease may need specialist ultrasound or MRI before treatment, even if earlier investigations were reassuring.
We discuss the intended treatment, alternatives and risks. Permission to look inside does not automatically include removing an organ or treating every possible finding.
Systematic inspection, recorded findings and biopsy where appropriate help guide care. We discuss what was seen and treated, what remains and any tissue results at follow-up.
I plan the gynaecological care and work with colorectal surgeons when bowel expertise is needed. Bladder or ureter involvement may require appropriate urinary-tract surgical expertise. We discuss who would undertake each part and the additional risks before consent.
A planned second operation may be appropriate if disease is unexpectedly extensive or the necessary preparation, expertise or consent is not in place. We agree the next step after reviewing the findings.
PREGNANCY & OVARIAN RESERVE
Surgery may help natural conception in some circumstances, but is not automatically the best next step. Age, time trying, symptoms, ovarian reserve and other fertility factors all matter. I work with fertility specialists when their input can help choose between trying naturally, surgery and assisted conception.
Removing an endometrioma before IVF is not routinely recommended solely to improve IVF success. Pain, concerning cyst features or access to the ovaries may change the discussion.
Both endometriomas and their treatment can affect egg reserve. Previous ovarian surgery or cysts in both ovaries make the trade-offs particularly important.
We consider whether reserve testing or a fertility-preservation discussion would be useful before surgery. Keeping an ovary does not guarantee unchanged fertility; plans should reflect your individual priorities.
REALISTIC EXPECTATIONS
Endometriosis surgery can reduce pain and improve quality of life, but the response varies. We identify the symptoms we hope to improve and practical goals such as easier movement, sleep or intimacy.
Pain can persist despite treatment, and symptoms or disease can return. Adenomyosis, pelvic-floor muscles, bladder or bowel conditions and a sensitised pain system may also need care. Smaller incisions can ease recovery compared with an open operation; the surgery inside may still be substantial.
Risks include bleeding, infection, injury to bowel, bladder, ureters or blood vessels, blood clots and anaesthetic complications. Problems can become apparent after discharge. Open surgery, further treatment or another operation may be needed.
Ovarian surgery and deep disease bring additional considerations. If bowel or urinary-tract treatment is contemplated, we discuss its specific effects and risks with the relevant surgical team.
BEFORE & AFTER SURGERY
Bring a medicine and allergy list. Follow your individual fasting and medication instructions. Arrange transport, support at home and time away from work or caring duties.
Tiredness, wound discomfort and temporary bloating or shoulder-tip discomfort can occur. Follow your pain-relief and wound-care plan, and build up gentle movement as advised. Worsening symptoms need assessment.
A short diagnostic procedure, ovarian cyst surgery and extensive deep-endometriosis treatment can have very different recovery needs. We discuss lifting, exercise, sex, driving and work for your particular operation.
Some patients go home the same day; others need a longer stay. Recovery depends on what was done and your health, not just the size of the cuts. Before discharge, make sure you know who to contact and when to return for review.
CARE AFTER ENDOMETRIOSIS SURGERY
We discuss the operation and tissue results, then review pain, bleeding, function and your priorities as recovery progresses. Early surgical discomfort and longer-term symptom response are different; we agree when to reassess.
Persistent pain deserves attention. We consider remaining or recurrent disease alongside other contributors and whether physiotherapy, medicines or further assessment could help. Repeat surgery needs a clear purpose.
If pregnancy is not an immediate goal, hormonal treatment after surgery may help manage symptoms and reduce recurrence. If you want to conceive, we plan the next steps around your fertility assessment.
We also discuss symptom flares and when to seek review. New or worsening symptoms should not simply be attributed to established endometriosis.
COMMON QUESTIONS
No. Laparoscopy looks into the abdomen and pelvis through small abdominal cuts. Hysteroscopy examines the womb cavity through the cervix. They answer different questions and may be combined when appropriate.
No. It describes the approach. Any planned organ removal needs specific discussion and consent. Hysterectomy is not a routine part of endometriosis surgery and does not guarantee a cure. It may help a separate problem such as adenomyosis; removing the ovaries is another decision.
Often it can be, when treatment is agreed beforehand and appropriate. Complex or unexpected findings may need further imaging, discussion or additional expertise before treatment. See how we plan the operation.
A systematic, documented normal laparoscopy makes endometriosis less likely. It does not make your pain less real. We review other contributors and a treatment plan. A negative biopsy alone does not exclude endometriosis.
Follow your procedure-specific advice. Driving requires recovery from the anaesthetic and sedating medicines, comfortable control of the vehicle and the ability to make an emergency stop; check your insurer’s requirements. Work plans depend on the operation and physical demands of your job.
Yes. Bring your questions and any previous reports. We can discuss suitability, alternatives and a second opinion before you decide.
MORE ABOUT MY SURGICAL PRACTICE
My practice also includes surgery for other gynaecological conditions and pelvic organ prolapse. Suitability and alternatives are discussed individually.
YOUR NEXT STEP
Consultations in Claremont, with additional appointments in Simon’s Town on selected Mondays. Reception will confirm your date, time and venue.
General information to support your consultation. Your treatment and recovery plan are individual.
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Sources & further reading: ACOG: laparoscopy · NICE: endometriosis · ESHRE: endometriosis guidance · RCOG: recovery · NHS: laparoscopy · NICE: fertility guidance, 2026 · ESGE/ESHRE/WES: deep-endometriosis surgery