How are women currently being mistreated for Endometriosis?
Let’s start with basic technique of treating small endometriosis. Simple endometriosis. There is a tendency of burning these lesions. Doctor sees it, looks at it through simple laparoscopy, he burns it. It is the simplest way to do it. It is the easiest way yet the worst way to treat the disease. Why is it worst? Why is burning very bad? What burning does is, basically you accelerate the pathology of endometriosis that really makes pain by burning. How do you do that? How does doctor with the wrong technique can contribute to the lesion become more painful? Because endometriosis actually causes pain due to scarring. Scarring pulls the tissue. It increases smooth lining of the peritoneal cavity in which the bowels swim. It makes it hard and thick. That is what scarring does. When you burn it, you make it more tense, more scarred. When you burn it, you also do not see, what has been underneath that. So basically you bury that. I have learnt through years of experience, these are the most difficult cases you may be challenged when you deal with previously burnt patients. So burning is not right.
Secondly, the endometriosis that is involving the ovary. Controversy is these endometriomas are potentially one of the worst endometriosis formats because endometrioma is like a second menstrual cavity. In other words, when women have periods, one period comes from regular uterus and flows through the vagina that is what they see. The other period, if you have endometrioma, is the period that occurs inside, it flows inside the peritoneal cavity. That blood never comes out. It accumulates and the ovary swells. Some doctors, unfortunately, this is so important, they just drain this, maybe remove a little part of the ovary, and they burn around the ovary. I think this is also unacceptable treatment. One needs to strip the capsule of this cavity endometrioma and probably reconstruct and maybe suspend the ovary, so ovary does not fall into the same hole and get stuck and cause pain and also reconstruct it so it does not have any adhesions of bowel coming there.
And thirdly, let me address about hysterectomy. Many women who undergo hysterectomy are with endometriosis, or are having hysterectomy for unnecessary reasons, because there are 600,000 hysterectomies done may be probably more in the United States right now. This number has not really changed. One third of this done is for endometriosis and/or pelvic pain.
What happens with hysterectomy is if there is adenomyosis, if the endometriosis is involving the uterus, I think it is a very indicative procedure. There is nothing else to be done for those women, if adenomyosis is attacking the whole uterus. However, if there is cul-de-sac disease, giving these women hysterectomy will not help at all to their pain. They will come back for painful intercourse or other sorts of pain in their pelvis. One has to treat the deep cul-de-sac disease with deep resection and wide excision of the anterior rectum and rectovaginal symptom. This is the surgery that belongs really to masters, to very experienced skillful surgeons and it is the technique that also needs to be taught to residents, to other doctors.