What is Endometriosis & its management? - Dr. B Ramesh скачать в хорошем качестве

What is Endometriosis & its management? - Dr. B Ramesh

Endometriosis is a very peculiar disease affecting all the age groups in women. Most commonly it happens during the reproductive age group and it contributes to 30 to 40% of infertility in women. It is the proliferation of the endometrial tissues outside the uterus. It can produce cyst and various other manifestations. Ovary is the commonest organ to be affected. It can also affect the uterosacral ligament, rectum, pouch of Douglus, bladder and it can involve any organ in the body, may be lungs and the brain sometimes. The main symptom is the person or the woman will have severe pain during their periods. Apart from that infertility or not able to conceive is another important symptom. Endometriosis is diagnosed by the history, clinical symptom, ultrasound, sometimes an MRI to rule out rectovaginal endometriosis. If it happens in young age groups of 15 to 20 years we can treat the patient with hormonal oral contraceptive pills or long acting progesterones or GnRH analogues. All these medicines produce amenorrhea so that the patient gets pain relief from this medication. In reproductive age group endometriosis has to be treated by laparoscopy. Laparoscopy is the god standard in the surgical management of endometriosis. We put the laparoscope, drain the cyst. If the cyst is more than 5 cms or bigger we prefer to remove the cyst wall and reconstruct the ovary. If the cyst is less than 5cm or smaller, we open the cyst and fulgurate the ovarian cyst wall. Laparoscopy is usually followed by GnRH analogues or progeterones for 3 to 6 months. After this the patient is started on ovulation induction drugs, follicular studies and the patient can try for pregnancy. If the patient cannot conceive and the tubes are good she can try cycles of IUI treatment. With IUI also the patient is not able to conceive finally the patient has to go for IVF treatment. In pregnancy treatment is not that successful as endometriosis because the quality of the drugs are affected in cases of endometriosis. In patients who have pelvic pain and have completed their family and child bearing we try to be more radical removing the entire cyst wall, the affected cyst and all the endometrial deposits in the pelvis and we try to remove the uterosacral ligament, shaving of the rectum and excision of the rectovaginal endometriosis. We follow this conservative treatment followed by prolonged therapy with progeterones or GnRH. In spite of this the patient is not getting the relief prefer to do radical surgery, i.e. total hysterectomy with laparoscopic bilateral salpingopherectomy with excision of all the peritoneal deposits and the rectal shaving procedure and the excision of the rectovaginal endometriosis. So with this treatment most of the patient’s symptoms and pain will recede in this case.