Surgery

In recent years, much new knowledge has been gained pertaining to certain pathologies, particularly those regarding fertility. Many innovations have taken place in surgical techniques, making surgery less risky and invasive. Endoscopy, otherwise known as ‘key-hole-surgery’ is when an optic fiber gets introduced into the cavity and allows visualization of the relative organ enabling it then to be operated upon.
Part of this technique is the laparoscopy, and the hysteroscopy.

The hysterectomy, one of the best-known gynecological operations, has become more sophisticated: there is the traditional abdominal approach, the vaginal approach, as well as the laparoscopic one.
The latter allows for the removal of the uterus with or without ovaries in a less invasive and traumatic way. Part of the key-hole surgery is the hysteroscopy whereby an optic fiber gets introduced into the uterine cavity allowing at the same time to operate in it.

Laparoscopy:

Laparascopia

Laparoscopy has made possible operations which allow the patient to go home the same day. Part of this is diagnostic laparoscopy allows the visualization of the internal organs as well as possible pathologies:

    Ovarian cysts and benign tumors
    Tubal pregnancy
    Uterine fibroids which are located externally
    Endometriosis
    Adhesions

Uterine Fibroids

Fibroids develop most in women between the ages of 35 and 50 years old under the estrogen stimulus, and tend to shrink during menopause. If fibroids become bigger they can cause abdominal heaviness and pain. If internally situated, they can set up a bleeding pattern with extreme cases of continuous, heavy bleeding and crampiness. Depending on their size and position they can be removed by laproscopy or hysteroscopy. In woman around 50 years old, this can be an indication for removal of the uterus (hysterectomy).

Polyps

These are benign tumors due to abundant growth of the lining, the endometrium in the uterine cavity. Polyps can be found situated internally or in the cervical canal and protruding onto the cervix. They too cause abnormal bleeding patterns and rarely pain. Removal is done by hysteroscopy or/and D & C.

Hysteroscopy:

Hysteroscopy

The Enigma of Endometriosis

What is Endometriosis?

Endometriosis is a painful chronic illness where tissue from the lining of the uterus (the endometrium) extends and adheres to areas beyond its usual site, for example to the pelvis or other organs.

Adenomyosis is a similar phenomenon where endometrial tissue is present within the muscle layer of the uterus.

Different Theories on How Endometriosis Develops

There are different theories as to how endometriosis develops. One is that the lining of the uterus finds its way into the pelvis through the Fallopian tubes and this could explain why endometriosis is more often found in childless women who, for obvious reasons, have more menstrual periods during their lifetime.

Another is that tissue that originates from embryos evolves into endometrial tissue and another is a combination of these theories.

Incidence of Endometriosis

Because it is often recorded only as part of another investigation, such as infertility or chronic abdominal pain, the true incidence of endometriosis is unknown.

In the US National Hospital Discharge Survey: 1988-1990 endometriosis was found in 11.2% of all women undergoing abdominal surgery for gynecological and non-gynecological reasons. Most estimates are that endometriosis is present in 2-3% women of reproductive age and in 50% of all women who present for infertility!

High Risk Factors for Endometriosis

    Ethnicity (higher incidence in Japanese women)
    Heredity
    Hormonal (estrogen status)
    Age, with peak at 40 years
    Frequent and heavy menstrual periods
    Body weight

Factors That Can Decrease the Incidence of Endometriosis

    Current and recent contraceptive use (lowers estrogen)
    Earlier natural menopause

Symptoms of Endometriosis

The common symptoms of endometriosis can include painful menstrual periods, painful intercourse, infertility, spotting between menstrual periods, irregularities in your menstrual periods, intermittent or chronic pain in the pelvic area with diarrhea, constipation, changes in bowel habit during menstrual periods, and rectal bleeding.

Recurrent endometriosis

Endometriosis is a progressive disease with a tendency to recur after treatment. Though the origin and recurrence of endometriosis is not perfectly understood, we have several therapeutic tools at our disposal to ease the pain and suffering it causes, confine the progress of the disease and very often to restore damaged tissues and fertility.