Over recent months I have seen an unusual number of patients with endometriosis in various scar sites. The most common situation follows the performance of a caesarian section with a deposit of endometriosis within the operative field. More rarely and usually without prior surgery (including laparoscopy) the umbilicus can be affected. Interestingly I have not…
The answer seems simple. The bowel surgeon should be involved early in the process. I agree. The bowel surgeon should ideally have the seen the patient in a pre-operative consultation to discuss the planned procedure, results and potential complications. The intra-operative timing is the critical thing. If the gynaecologist has minimal surgical skills then invariably…
I have recently been asked this (or a very similar) question at a number of meetings. I have given this issue considerable thought over the years. The most common response I receive from both trainee surgeons and colleagues is that yes the surgeon should call for assistance in the event that there is unplanned damage…
A recent consensus statement on endometriosis and infertility indicates that some women may benefit from a combination of assisted reproduction and surgery. Unfortunately the data are limited and somewhat conflicting. This is not uncommon when surgery is involved as there is inevitably a degree of operator (or surgeon) dependence. It is self-evident with diseases such…
Premenstrual spotting is an important characteristic sign of endometriosis. It usually takes the form of dark or brown staining or spotting lasting more than 12 hours prior to menstruation beginning normally. This association has been known about for some time but has not been well appreciated by doctors or gynaecologists. There appears to be…
Over the last few years I have travelled to Hong Kong and China to operate and run surgical workshops where I have had the honour of teaching and working with other specialist gynaecological surgeons. I am registered as a specialist gynaecologist in Hong Kong and have been accredited to operate as an advanced level laparoscopic…
A recent report published in Lancet Oncology has raised again the possibility that endometriosis and certain types of ovarian cancer may be closely linked. The authors admit that further analysis is required although suggest that people should consider ongoing surveillance. Unfortunately there are significant problems with the data particularly the patient recollection of a…
I had a fascinating discussion with a dentist recently in relation to gum disease (periodontal disease) and other chronic inflammatory diseases. Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, rheumatoid arthritis and now possibly endometriosis. There are various grades of severity of periodontal disease and…
I have just returned from the United States and have had the opportunity to discuss healthcare systems with a number of gynaecologists there. Having had these conversations and others over the years with other gynaecologists having a similar practice it strikes me that whilst the US is good in the main part for many people…
Over the years I have unfortunately seen multiple people who have had a large number of laparoscopies before finally having definite surgery. The most recent was a 37 year old woman with severe endometriosis who had had at least 12 laparoscopies and several cycles of IVF all of which were unsuccessful before finally having excision…