Endometriosis Foundation

I just returned from the World Congress of the AAGL. Our keynote speaker was Padma Lakshmi. She is a co-founder of the Endometriosis Foundation of America. She is better known for her show on Bravo network, Top Chef. She shared her endometriosis story with us and her devotion to education of this debilitating disease.

She suffered with pelvic and abdominal pain for 26 years before she was finally diagnosed with endometriosis. After finding a surgeon skilled in surgical excision of endometriosis she began her road to recovery. Three surgeries later she is now pain free and has a beautiful daughter.


I echo her statement and the opinion of the Endometriosis Foundation of America, that surgical excision is the "gold standard" treatment for endometriosis. The current average years to diagnosis is around ten years. As we educate parents and young women about the signs and symptoms of endometriosis, hopefully we can begin to prevent the most severe forms of the disease that can affect so many aspects of women's lives.

Removal of Cervix after Supracervical Hysterectomy or LSH

I have had a few patients who have presented to me for problems after a supracervical hysterectomy or LSH. This type of hysterectomy is typically performed laparoscopically. The uterus is divided into two portions; the top or fundus, and the bottom or cervix. As described in a previous post in January of 2007, the supracervical hysterectomy can be a good procedure for patients desiring a fast recovery. There is also some benefit by not disrupting the existing supportive ligaments that attach at or near the level of the cervix.

However, up to 30% of patients may need to have the cervix removed at a later date due to continued bleeding, continued pain, or other problems. Most of the patients I have encountered request removal of the cervix due to continued pelvic pain or pain with intercourse after having a supracervical hysterectomy.

Removal of the cervix can be completed by three different methods. It can be removed by vaginal surgery. The risk with this method is the possibility of adhesions to the amputated cervix. Another method is through a laparotomy or large incision. The third method is with the laparoscope. Much in the same way a hysterectomy is performed, the laparoscope allows evaluation of the abdominal cavity for adhesions and also allows completion of all or part of the removal of the cervix.

As with hysterectomy patients are chosen for method of removal based upon their risk of adhesions, continued pain, and amount of cervical descent. Offering laparoscopy allows the physician and patient to choose between all available methods for surgery.

Endometriosis

I recently had a patient present with pain during periods and deep pain during intercourse. On her physical exam I felt a nodule or mass at the top of the vagina. This can be very common in patients with endometriosis. At the time of her surgery she had a thick endometriosis nodule behind her uterus that corresponded to the findings on physical exam. This is a very common place to find endometriosis. One of the difficulties with endometrisosis in this area, is that it can grow in close proximity to the ureter. That is a tube that carries urine from the kidney down to the bladder. A surgeon must be careful in dissecting this area to avoid injury to the ureter. I usually just use my scissors without any electricity or very minimal. If there is extensive endometriosis in the ureteral area, it may be necessary to close the uterine vessels on the same side to avoid significant bleeding durring removal of the endometriosis.

Some patients may also have endometriosis cysts on the ovary. These are referred to as endometriosis cysts or "chocolate cysts." The fluid and old blood inside the cyst often as a liquid chocolate appearance when opened. These are best treated by actually opening the cyst and removing the wall of the cyst. Any minor bleeding can be controlled with cautery or with large cysts, the cyst bed can be sewn closed.