Dr. Ceana Nezhat’s pioneering work in laparoscopy has changed the face of treatment for women suffering from Endometriosis. Through extensive teaching of his techniques in the diagnosis and treatment of Endometriosis to teams around the world, Dr. Nezhat had made it his personal mission to spread awareness of this disease and to better the lives of patients from all over the globe including rare and complicated cases.
Dr. Nezhat speculated if extensive endometriosis can be managed laparoscopically, practically all other pathology can be dealt with via laparoscope without resorting to major abdominal surgery. Dr. Nezhat has introduced many new techniques for laparoscopic management of endometriosis involving ovaries, bowel, bladder, diaphragm and other parts of the body. He has taught many surgeons and their teams his technique, and he and his team have won numerous awards for their medical accomplishments in educational endeavors.
During the menstrual cycle, the lining of the uterus, called the endometrium, builds up, breaks down, and sheds, leaving the body through the vagina. When this type of tissue is found outside of the uterus but still responds to hormonal cycles it is called Endometriosis. When endometrial growths (often called implants) react to the menstrual cycle or hormone fluctuations the result is internal bleeding, which causes inflammation, pain, build up of scar tissue and adhesions, and can cause infertility.
Common sites of endometriosis are the ovaries, fallopian tubes, the ligaments that support the uterus, between the rectum and vagina, and the lining of the pelvic cavity. In addition, endometriosis can affect the bowel, bladder, ureters, and appendix. There have even been cases of endometriosis on the diaphragm, lung, and other areas of the body. This is referred to as extra-genital endometriosis.
Who is Affected by Endometriosis?
Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect over 70-million women worldwide with estimates ranging from 3% to 18% of women in the United States alone. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy in this country. While most cases of endometriosis are diagnosed in women aged around 25-35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis is more commonly found in Caucasian women as compared with African American and Asian women. Studies further suggest endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.
Of those who do experience symptoms, the common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain or cramping with intercourse, bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.
Pelvic pain in women with endometriosis depends partly on where the implants of endometriosis are located.
– Deeper implants and implants in areas with many pain-sensing nerves may be more likely to produce pain.
– The implants may also produce substances that circulate in the bloodstream and cause pain.
– Lastly, pain can result when endometriosis implants form scars.
There is no relationship between severity of pain and how widespread the endometriosis is. Endometriosis can be one of the reasons for infertility in otherwise healthy couples.
Other symptoms related to endometriosis include: lower abdominal pain, diarrhea and/or constipation, low back pain, irregular or heavy menstrual bleeding, or blood in the urine.
Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.
During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen during laparoscopy.
First you should know that there is no cure for endometriosis. Medications can be prescribed to help control pain and may lessen the effects or progression of the disease. Surgery can treat the disease. But at this point, there is no definitive cure.
Patients with endometriosis may present with different clinical complaints at various stages of disease. Treatment depends on the age of the patient, the extent of disease, severity of symptoms, and desire for future fertility. Intervention usually is indicated for pain, infertility, or impaired function of the bladder, ureter, or intestine.