Why surgery is indicated and why some patients are scared of having (another) surgery? by Dr Gabriel Mitroi
I am often asked by patients who are coming for a consultation and have been suffering for years with deep endometriosis affecting the intestines, bladder, etc., a very pertinent question: Why should I have surgery if the disease has no cure and after surgery, it will recur?
This question has to do mainly with the fact that patients that have been suffering for years with pelvic pain (5-10 years) and have had bad medical experiences. Endometriosis patients that most of the time put their own diagnosis, have been neglected by various medical specialities, or in some cases, have been diagnosed with endometriosis but had incomplete surgeries.
Very often patients are having surgery for ovarian endometriosis only; all other tissues are left behind. The patient will, therefore, continue to have severe pain after such surgeries, in some cases of a higher intensity, and in other cases, might be a minimum of symptoms relief. In some happy cases, a patient becomes pregnant after an incomplete surgery and by the time s/he sees a specialist in endometriosis, the disease has progressed.
As per some of the studies, it seems that endometriosis is a genetic disease, with an etiology still incompletely explained and with multiple triggers for symptoms and disease progression: nutrition, environment, hormonal, etc. As Dr D. Redwine has said, until we find a genetic treatment for endometriosis, the only therapeutic method is excision combined or not with an adjutant treatment (similar to malignant neoplasms).
That’s why surgery is indicated for all symptomatic patients with deep endometriosis. On the other hand, in cases of asymptomatic patients who do not (longer) want kids, the recommendation for such patients is to be monitored quite closely, especially if the patient does not wanna have surgery, which can be quite complex.
I personally do understand patients who have gone through 3-4 surgeries (sometimes even more) for endometriosis; surgeries that, unfortunately, were done wrong due to the lack of experience of the medical team. As a result they lost their confidence in doctors and in most cases they prefer to suffer in silence.
It is very useful for both the patient and the doctor to know about the therapeutic possibilities of endometriosis, to avoid unnecessary surgeries (incomplete), that sometimes are harmful. I am confident that in a few years time, a lot of gynaecologists will be able to recognise the signs of the disease, will make a correct pre-operative assessment, will recognise all endometriosis lesions during surgery and will be able to treat them correctly.