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Paul MacKoul, MD, FACOG
Pelvic Pain Endometriosis & Adhesive Disease
The Center for Innovative GYN Care
. http://innovativegyn.com/

Pelvic Pain Endometriosis & Adhesive Disease

Pelvic pain is a common and difficult problem facing a significant number of women today. Acute pain with menstrual cycles can be debilitating with loss of work and time from family, resulting in poor quality of life.
Endometriosis is the most common cause of pelvic pain in patients who have not reached menopause. It is thought that this condition results when the lining of the uterine cavity, called the endometrium, is transported through the fallopian tubes to the pelvis. Endometrial tissue that implants and grows on the surface of the uterus, the ovaries, the fallopian tubes, or the lining of the pelvis is called endometriosis. With each menstrual cycle, estrogen causes further growth of the endometriotic tissue on these surfaces, which causes scarring and pain.
Endometriosis is initially treated with minimally invasive laparoscopic surgery to confirm the diagnosis and to remove as much of the endometriosis as possible. Advanced laparoscopic procedures are sometimes necessary to remove implants near the bowel, bladder, vessels, and near the ureter. Surgical removal gives relief from pelvic pain, and also may help with fertility, since endometriosis is a common cause of infertility.
Advanced laparoscopic procedures remove disease with only four 1/4 inch incisions, and almost all patients are able to go home the same day of the surgery. Recovery is excellent, with return to work within 7-14 days, and minimal pain postoperatively. Medical therapy is often used to suppress estrogen production from the ovaries. This is important since estrogen will lead to further growth of endometriotic implants if not suppressed. Left untreated, endometriosis can lead to severe scarring within the pelvis. Complete removal of this scar tissue will help decrease pain.
Another major cause of scarring is infection in the pelvis. Tubo-ovarian abscesses occur from an infection of the ovary, often sexually transmitted. These abscesses will adhere to surrounding structures, causing pressure and pain from scarring and adhesions. Treatment is usually surgical, with removal of the adhesive disease (scar tissue) and often removal of the ovary and tube that are affected as well. Laparoscopic surgery can be used for this condition, with all the previously mentioned advantages. Most patients are able to leave the hospital the same day.
Finally, those patients that have had multiple prior surgeries are also prone to develop scar tissue and adhesions that cause pain. Every time surgery is performed, a cut is made that is repaired by the body. Open surgical procedures require abdominal incisions that result in scar tissue inside the body on the abdominal wall, often resulting in bowel and other tissues sticking to the abdominal wall. The larger the incision, the more repair and subsequently more scar tissue and adhesions are formed.
The best way to avoid adhesions is to limit the size of the surgical scars, and to use careful techniques when performing surgery. Laparoscopy has great advantages over open surgery with regards to formation of scar tissue and adhesions, since incision size is very small, bleeding is minimal, and there is little manipulation or damage to tissues during the surgery.

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