Prof Igno Siebert, a fertility and endometriosis specialists from Aevitas Fertility Clinic, recently spoke to Marie Hudson, on ‘Gesondheid op RSG’ on the topic of Surgical treatment of endometriosis. Follow the link to tune into the podcast ‘Gesondheid 8 Augustus 2018‘. Alternatively, a summary of the interview follows below:
What is endometriosis?
Endometriosis can be best described as glands which form on the outside of the uterus, which are normally found on the inside. With monthly menstruation, glands from inside the uterus wall are secreted. One theory for the development of endometriosis is that the secretion of these glands flow back through the tubes and form on the outside of the uterus, within the pelvic cavity. This causes inflammation and irritation to the areas in which it manifests and can be imagined as a grass burn. The endometriosis causes pain and symptoms to areas it gets in contact with and attaches to e.g. ovaries, intestines.
If you need surgery for endometriosis, what should you know?
If a woman has been diagnosed with endometriosis, it’s important that she is treated by a physician with knowledge and treatment expertise on endometriosis. Furthermore, if she is advised to undergo a second surgery she needs to ask the questions: ‘why is a second surgery needed?’ Perhaps the first surgery was not as successful as hoped, as the endometriosis has affected other areas, such as the intestines or bladder. Gynaecologists in South Africa are very well trained and can deliver excellent service. However, if you require a second surgery, perhaps it’s also time to request a second opinion.
Why is the surgical treatment of endometriosis difficult?
1. Diagnosing the severity of endometriosis is complicated
The extent of endometriosis can’t be diagnosed purely with a history or sonar, which complicates the planning of treatment.
Clinical signs of endometriosis include:
- painful menstruation
- chronic pelvic pain
- painful intercourse
Having the above symptoms does not mean you have endometriosis. However, if you do not have the above symptoms it does not mean you do not have endometriosis. Furthermore, through an ultra-sound one can only determine if a cyst has formed due to endometriosis.
2. Surgery for deep infiltrating endometriosis is a team effort
Endometriosis can spread to other areas (not just the female reproductive system) such as the bladder, the intestines, the kidney etc. We even had a case where endometriosis manifested on the diaphragm, causing severe shoulder pain. The shoulder pain was so intense a diagnostic shoulder arthroscopy was performed, only to find no causing factors in the shoulder. It was later discovered that the referred pain was due to endometriosis.
Gynaecologists do not operate on the intestines, kidney pipes etc, therefore if a second surgery is needed, the endometriosis might have spread to other areas within the pelvic cavity, which was previously missed. It is important for the physician to determine as closely as possible where the endometriosis has spread to, in order to get the right surgeons on board and make the surgery as successful as possible. Prof Siebert’s school of thought on the topic of surgical treatment of endometriosis:
- “If you do not know what you are operating, why are you operating?”
- “Plan for one surgery and address all the areas affected by endometriosis”
In conclusion: Deep infiltrating endometriosis (affecting more areas than the reproductive organs) need to be addressed by a team of knowledgeable and experienced surgeons. The extent of endometriosis needs to be diagnosed and planned for, as accurately as possible, prior to the surgery, in order to avoid repetitive surgeries. A list of endometriosis specialist within South Africa can be requested from SASREG.
*Follow the link should you wish to read more about what Prof Igno Siebert has to say about endometriosis or to learn more about gynaecological surgical treatment. Furthermore, you are also welcome to contact Aevitas Fertility Clinic for further inquiries.