Infiltrating endometriosis | Endometriosis of the sciatic nerve
Endometriosis is one of the most common gynaecological conditions. It affects around 1 in 10 women. In endometriosis, cells from the uterine lining – the endometrium – spread outside the uterine cavity. They can settle on the pelvic peritoneum, ovaries, bladder or intestine, and even on the lungs or kidneys. Because endometriosis lesions are subject to cyclical changes in hormones, they grow and release neurotransmitters that cause pain in the lower abdomen during the menstrual period. In many women, the pain extends down to the leg or lower back. Sometimes it can feel like lumbago or irritation of the sciatic nerve. Endometriosis can occur at all stages of life and is a chronic but curable condition that may require repeated intervention. If it is not treated, endometriosis can lead to long-term infertility.
Laparoscopic surgery is the gentlest and most effective method of treating severe endometriosis. The endometriosis is completely removed in this procedure, while the pelvic organs and their functions are preserved. Removal of the uterus or ovaries is not usually necessary and also not desirable if the patient wants to have children at a later stage.
When endometriosis occurs in the region between the intestine and the vagina, it is known as deep infiltrating endometriosis in the rectovaginal septum. In this case, endometriosis can affect the rectum, ureters, bladder and even the pelvic nerves that control the rectum, bladder and sexual function. Extensive endometriosis of the rectum can lead to intestinal obstruction, bleeding from the bladder, blockage of the ureters and irreversible kidney damage, and even destruction of the bladder wall. Surgical removal of the endometriosis is necessary in this severe form, along with removal of parts of the organs affected. This can be performed using laparoscopic or open surgery.
Endometriosis can also affect the sciatic nerve and all pelvic nerves, including the obturator nerve (a lumbar nerve) and the femoral (thigh) nerves. Hormone therapy is not effective in endometriosis of the pelvic nerves – it even carries the risk of unnecessarily delaying surgical treatment of the disease. Surgical treatment is necessary to avoid irreversible damage to the nerves leading to motor deficits, particularly raising and lowering the foot. Removal of endometriosis on the sciatic nerve is the most demanding of all pelvic procedures. The use of tiny cameras provides for minimally invasive, highly precise treatment with the best possible protection of the nerves.
The Endometriosis Centre Zurich/Switzerland which is headed by Professor Possover offers individual consultation and treatment based on the latest medical and scientific knowledge. All forms of endometriosis are treated here, from simple to complex cases. The surgical procedures are almost always performed using laparoscopic surgical techniques. Professor Possover specialises in laparoscopic surgery for severe endometriosis and is the world’s leading expert in laparoscopic treatment of sciatic nerve endometriosis.