In most cases of endometriosis, the disease only involves the peritoneum, the thin saran-like wrap that cloaks the pelvic structures. Sometimes, however, endometriosis can be invasive and burrow into the tissue beneath the peritoneum, such as the bowel, bladder and ureters. Occasionally the disease will also be found in distant sites, such as the diaphragm.
If deeply invasive endometriosis is present, this demands a high level of surgical expertise on the part of the surgeon, in order to safely and successfully remove the disease from the delicate and vital structures beneath the peritoneum.
Due to his years of experience in treating many advanced cases of endometriosis via minimally invasive surgery, Dr. Cook has developed the skills required to carefully remove the disease from all of these locations while minimizing complications. This includes, resecting full-thickness nodules of endometriosis from the wall of the bladder, from the small and large bowel and from the space occupied by the ureters.
When bowel disease is very extensive, it is sometimes necessary to perform a segmental bowel resection. This is when the segment of bowel involved by the invasive disease is removed and the two remaining ends are reattached, leaving just healthy bowel behind. In these cases, a general surgeon is on hand to assist with the segmental resection. Dr. Cook performs almost all bowel and urinary tract work himself although has the assistance of a multidisciplinary surgical team when required.
In most cases of bowel disease, however, a segmental resection can be avoided. Dr. Cook’s strategy is to completely remove all areas of disease while preserving your organs and avoiding unnecessarily aggressive procedures that carry higher risks of complications and a longer recovery time.
In the case of suspected diaphragmatic disease, an extra port may be placed just under your lowest right rib to enable full visualization of the area of diaphragm behind the liver, which is the most common site of diaphragmatic disease. If diaphragmatic disease is present, Dr. Cook will carefully treat it.
Whenever invasive endometriosis is suspected, the patient will be fully informed and counseled about the surgical procedures that may be involved in removing these areas of deep disease, the recovery process and any possible complications that could arise from this advanced surgery.
Providing the time to listen to and answer all patient concerns prior to surgery is essential with any surgical procedure but could not be more the case when a patient faces advanced surgery for endometriosis. At Vital Health we schedule several pre-operative phone and in-office consults to ensure that you have all the time you need to ask any questions you may have and to process the information you receive so that you feel confident and reassured when going into surgery.