Endometriosis is a chronic proliferative disorder and needs treatment aggressively to provide relief from its symptoms and arrest progression of the disease. Treatment options include medical or surgical or a combination of both. We offer the option depending on the individual patient needs and desires and most importantly the symptoms and the severity of her disease Our surgical strategy to tackle endometriosis is as follows MANAGEMENT OF ENDOMETRIOMAS MANAGEMENT OF RECTOVAGINAL ENDOMETRIOSIS RESECTION OF ENDOMETRIOTIC BOWEL IMPLANTS HYSTERECTOMY FOR ENDOMETRIOSIS Read more
Since March 2001 we have been using this novel spray substance SprayShield™, (formerly SprayGel) to prevent adhesions following gynaecological surgical procedures. In general, adhesions are formed after all surgical measures involving laparotomy. But even during laparoscopy, which is a form of minimally invasive surgery, wound surfaces can be formed during certain procedures, such as for example endometriosis or myoma operations. These surfaces can adhere to each other, thus forming adhesions. These adhesions can later cause problems such as pain, adhesion of the uterine tubes (infertility) or of other organs (intestines / ovaries / uterus). They thus have the potential to cause chronic problems and pain requiring tedious treatment measures, and possibly even adhesiolysis, a follow-up surgical procedure to remove these adhesions. The new gel substance (SprayShield™) is sprayed onto the wound surfaces, where it remains in place for some days after surgery. Since adhesions are formed within 7 days of surgery, the barrier system thus prevents formation of adhesions. After this period, SprayShield™ is then broken down and simply absorbed by the peritoneum and excreted from the body via the kidneys. The carbon dioxide customarily used to insufflate the abdomen during laparoscopy converts the entire peritoneum into an acidic environment. This thus results in oxygen being withdrawn from the tissues and can cause cells to die, with formation of global wound surfaces in the peritoneum and abdominal organs By using gasless laparoscopy, we avoid insufflation with carbon dioxide, which has been shown by recent studies — for the aforementioned reasons — to be a co-factor adhesion formation. But since wound surfaces are always formed during surgery because of tissue layers being separated, the formation of adhesions can additionally be prevented on such surfaces by spraying them with SprayShield™. Hence in the gasless laparoscopy technique and SprayShield™ we have an ideal combination that helps to prevent the occurrence and formation of adhesions. Dr Kruschinski has now performed adhesiolysis on around 500 cases using the technique of gasless adhesiolysis with spray gel application Adhesions are known to form as soon as three hours after the completion of a surgical procedure – and will continue to form for up to about seven days. If any adhesions have formed during this critical time period, they can easily be “swept down” by the surgeon during a second look laparoscopy – and more SprayShield can be applied, if needed. Dr. Daniel Kruschinski is one of the very few surgeons in the world, who performs a second look laparoscopy (SLL) about seven days after the initial surgical procedure. In Dr. Kruschinski’s experience the risk of adhesions resulting in the need for a subsequent surgery is greatly reduced. He has mastered the required advanced microsurgical laparoscopic techniques and has logged thousands of hours in performing very difficult, time-consuming, risky surgical procedures. Repeat surgery for adhesions in these cases is usually less extensive and does not usually involve the same amount of dissection that led to the formation of adhesions in the first place Read more
Adhesions are formed after all surgical measures involving laparotomy. But even during laparoscopy, which is a form of minimally invasive surgery, wound surfaces can be formed during certain procedures, such as for example endometriosis or myoma operations.
These surfaces can adhere to each other, thus forming adhesions.
These adhesions can later cause problems such as pain, adhesion of the uterine tubes (infertility) or of other organs (intestines / ovaries / uterus).
They thus have the potential to cause chronic problems and pain requiring tedious treatment measures, and possibly even adhesiolysis, a follow-up surgical procedure to remove these adhesions.
The long-term success of many different surgical procedures can be improved by the use of barriers that act as “internal bandages” and prevent adhesions
The goal of conservative surgery is to aggressively remove as many endometrial implants and cysts as possible without causing surgical scarring and subsequent adhesions that could hamper future fertility. The two conservative surgical routes used are either laparoscopy or laparotomy. Improving Fertility. Surgery has been shown to improve infertility rates in women with severe endometriosis (stages III and IV). Some physicians recommend conservative surgery even in early-stage endometriosis, because of the progressive nature of the disorder and there is some evidence that it improves fertility. Fertility can often be restored even if the surgery does not remove all the endometrial implants. However, the best fertility rates in such cases occur in the early postoperative period. They decline over time if implants have not been completely eliminated. Subsequent surgeries become less effective in restoring fertility. Reducing Pain and its Recurrence.Studies report pain reduction after surgery in more than 60% of women. Conservative surgery, however, can miss microscopic implants that may continue to cause pain and other symptoms after the procedure. Laparoscopy is now the gold standard treatment for endometriosis. It is usually done under general anesthetic and involves the following:
Endometriosis is a common condition affecting women. It is a chronic, painful, and often progressive disease in women. The causes of endometriosis are unknown.It has widel variability in symptoms and severity, so diagnosis is at times difficult.Endometrial Implants Endometriosis occurs when cells from the mucus membrane lining the uterus (endometrium) form implants that attach, grow, and function outside the uterus, generally in the
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Dr. Kruschinski, medical head of the Endoscopic Gynecology Centers in Germany & has been actively involved in endoscopic gynecology for the past 18 years. As specialist for this discipline Dr. Daniel Kruschinski is one of the most frequently invited German speakers to international congresses, symposia, workshops and surgical tutorials. Gasless laparoscopy, which dispenses with insufflation […]