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Excision of endometriosis12/24/2023 ![]() At best, such a course of therapy provides only a temporary means of symptom improvement, not definitive treatment. The disease does not simply ‘go away’ as a result of drug suppression. While always an option for those who desire it, medication does not eradicate endometriosis. In the general healthcare community including at the OB/GYN level, it is taught (and hence practiced) that the most frequent mainstays of treatment are medical suppressives and incomplete surgery. Endometriosis can also cause physical and psychological damage when left untreated or treated unsuccessfully … yet incalculable misunderstandings and lack of knowledge about the disease persist. Often dismissed as simple ‘killer cramps’ that are ‘normal’, or worse, ‘in your head,’ the disease – without question - causes considerable negative impact on quality of life, especially in the domains of pain and psychosocial functioning. To answer this question, one must understand the stark understanding and bias surrounding endometriosis. Endometriosis treatment is not one-size-fits-all, and patients need a specialist who will work with them on a personalized care plan - when the plan involves surgery, it is imperative the surgery be performed by those with advanced skill. It is also imperative that a patient-centric, judicious - even conservative - approach is utilized planning each individual’s case based on their very specific needs and desired outcomes is critical. then disease will be missed and left behind untreated surgeons can only see and treat what they recognize. This means, if the surgeon is not familiar with all signs of endometriosis including those less common such as subtle areas of peritoneal tension, atypical clear vesicles, extrapelvic endometriosis, etc. ![]() Likewise, accuracy in diagnosis and treatment is dependent on the ability of the surgeon to recognize disease in all its different manifestations. Just as it matters who reads and interprets imaging and other studies, who performs the surgery, how and when is of critical importance, as excision is a highly advanced surgical technique requiring extensive training. The choice to intervene surgically should be the patient’s after fully informed consent and thorough discussion of the pros and cons of all approaches. Hence, absence of evidence is not evidence of absence. It is of course prudent to rule out differential diagnoses and use all tools in the armamentarium, but physical examination, imaging and lab studies related to an endometriosis diagnosis commonly have poor sensitivity, specificity and predictive values - and are more importantly, very highly operator-dependent. In addition, a ‘non-biopsy approach’ to diagnosis dilutes the research effort conducting studies on uncertain or induced “endometriosis” leads to uncertain results and hinders progress. Dismissing these indications and hindering access to timely surgical diagnosis and treatment - which can and should be accomplished in the same surgical encounter - only confound the patient’s scenario further. Pelvic pain has many generators, and endometriosis often presents with a unique constellation of symptoms and may be accompanied by other conditions nor should non-classic signs be undervalued i.e., soft tissue, lung or diaphragmatic disease bowel or bladder-only symptoms. While “medical diagnosis” is growing in popularity, it is still simply not possible to obtain biopsy-proven confirmation without surgical intervention. Read on to check out some common endometriosis/excision Q&As below:Ĭan’t Endometriosis be Diagnosed without Surgery? For more on excision, check out " Dr Albee on Excision." To date, the CEC has treated thousands of individuals from nearly 70 countries, performing over 13,000 combined procedures, with excellent long-term outcomes in the majority of our patients. While not everyone is a candidate for surgery and excision is certainly not a definitive/universal “cure,” LAPEX is associated with improved pain and quality of life for many. ![]() ![]() Generally speaking, LAPEX allows for the disease to be properly, meticulously removed – cut out – from all areas, without damaging surrounding structures or removing otherwise healthy organs. Laparoscopic Excision (LAPEX) is the surgical cornerstone of any high quality, multidisciplinary approach to treating endometriosis. SEE ALSO: WHAT TO EXPECT FOR YOUR SURGERY AT THE CEC BY WENDY WINER, RN, BSN, CNOR, RNFA ![]() Late 16th century (in the sense 'notch or hollow out'): from Latin excis- 'cut out', from the verb excidere, from ex- 'out of' + caedere 'to cut'.-Oxford Dictionaries Excise: to cut out surgically to remove by cutting. ![]()
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