Preparing the bowel before a laparoscopy is considered 'good insurance'. During surgery, if there's a hole and a bowel prep (done beforehand), then we just sew the hole. If we make a hole and there was no bowel prep, then you're looking at a colostomy.
You can get cancer in an endometrioma. I've seen two cases in 16 years. If the ultrasound shows both solid and liquid in the mass, then we'll do a laparotomy.
Subtle lesions of endo cause more pain. Adhesions come from scar tissue and are caused by: endometriosis, infection and previous surgery. Raw surfaces attract and want to stick back together. There have been advances in preventing adhesions. In December '01 the FDA approved a Johnson and Johnson product called "Intergel". This product isn't perfect but we find a 60% reduction in adhesions with its use. Intergel can only be used during a laparotomy. Intergel isn't perfect---we've seen patients be re-admitted to the hospital within 2-3 weeks after surgery where Intergel was used. These patients present with pain and fever. We admit them for a few days, give them pain medication and monitor them. Most likely, they're experiencing a chemical reaction to the gel as it reacts with the fibroblasts. We have to make sure the gel doesn't get in any wounds, and a patient's belly is very distended for a few weeks after surgery as the stuff sloshes around, preventing the raw surfaces from touching.
Medications don't help adhesions. A frozen pelvis means that everything in there is stuck together. Adhesions can cause bowel obstructions.
A hysterectomy and ovary removal will give a 90%+ range of success in reducing endometriosis symptoms. We may not get rid of all of it during surgery because of the microscopic remnants. We have to explore the bowel during a hysterectomy and feel the intestine up and down to make sure there's no blockage. After a hysterectomy, we give patients a prescription for "Estrotest HS" (half-strength), which is a combination of low dose estrogen and low dose testosterone. She can fill the prescription anytime depending upon the side effects she feels after the surgery. We can maintain the cervix now during a hysterectomy whereas before we took it, too.
The "Kistner Technique" is a low dose Pill taken continuously, which puts the body into what's called "pseudopregnancy". Patients should start on the Pill first, monitor their symptoms, and then only go on to take Lupron if they have breakthrough pain while on the Pill. Dr. Hornstein (Mark Hornstein at the Brigham) just got a NIH grant to research Lupron and the Pill and their differences. Now there's a Pill called Seasonale where women who take it only have a period four times a year. If you don't take some kind of medication after surgery for endometriosis, within 1-2 years you're back in pain and facing another laparoscopy.
Depo-Provera is the most commonly used birth control in the world. We give the shot for three months at a time. If we just gave it in a one month dose, no one would take it again because of the side effects, which usually take three months to subside. Lupron is used for: endometriosis, prostate cancer and precocious puberty. A patient starts Lupron for three months with add back estrogen, like 5 mg. of Agestin. This is called the Estrogen Threshold Hypothesis, or "add back", which is taking enough estrogen to preserve bones and prevent side effects while on Lupron.
Women who still have pain after a hysterectomy and aren't taking HRT may be influenced by the estrogen found in their fat cells.
Hospital-based acupuncture now is OK'd by most health insurance.
I've seen patients as young as eight years old with endometriosis---girls who have endometriosis before their period even begins; in one case, before the girl even had any breast tissue.
From another member:
Here are brief clippings of notes I took. Excuse the fragments... but I am short on time. Many things you already know...