Dr. Ronald Enrique Delgado Bocanegra
Dr. Ronald Enrique Delgado Bocanegra, Endometriosis Specialist
City: Salvador, Bahia, Brazil
Philosophy of Endometriosis Care: My approach to the treatment of endometriosis is grounded primarily in the embryonic theory of origin, as proposed by Dr. David Redwine. According to this theory, endometriosis results from the aberrant differentiation of embryonic Müllerian remnants, which persist outside the uterine cavity and later develop into endometriotic lesions. This perspective shifts the focus away from retrograde menstruation and toward the concept that endometriosis is a congenital disease — present from birth and not caused by menstrual backflow. It explains cases in premenarchal girls, women with Müllerian anomalies, and the presence of endometriosis in distant locations that retrograde menstruation can’t account for. Clinically, this theory supports a surgical approach that emphasizes complete excision of all visible and suspected disease, rather than ablation or suppression. It also reinforces the idea that endometriosis is not a recurrent disease if completely removed — recurrence is often due to incomplete excision. Therefore, my goal is to perform meticulous, fertility-preserving excision surgery whenever possible, aiming for long-term relief and definitive treatment
What type of surgery do you perform for endometriosis: Excision
Medication: Grounded in the embryonic theory of endometriosis, I view the disease as congenital and not caused by retrograde menstruation. Therefore, my primary treatment is complete surgical excision, aiming for definitive management. Medications are used as supportive tools in two main contexts: before surgery, to manage symptoms temporarily when immediate surgery isn’t feasible. After surgery, in selected cases — like when there’s a residual microscopic disease or when fertility preservation is a priority. I typically use: Continuous combined oral contraceptives, Progestins (like dienogest) GnRH analogues with add-back therapy These options help control symptoms but don’t cure the disease. The focus remains on individualized, surgical-centered care.
Approach to Persistent Pain After Surgery: When patients experience persistent symptoms after surgery for endometriosis, my approach is comprehensive and individualized. First, I assess whether the symptoms are due to residual disease, coexisting conditions, or central sensitization. Persistent pain doesn’t always mean recurrence — it could be related to pelvic floor dysfunction, adenomyosis, irritable bowel syndrome, interstitial cystitis, or neuropathic pain. If I suspect residual or recurrent disease, I review the surgical report and imaging and may repeat diagnostic imaging with an expert. In some cases, reoperation may be necessary, especially if the initial surgery was incomplete. If other causes are identified, I work with a multidisciplinary team — including pelvic physiotherapists, pain specialists, gastroenterologists, and psychologists — to address the symptoms holistically. Medication (like progestins or neuromodulators) can also be used as part of symptom control, but not as the sole strategy. In essence, I treat persistent symptoms not with a one-size-fits-all approach, but through careful reassessment, patient education, and a multidisciplinary plan tailored to each woman’s needs.
Dr. Ruy Machado Jr.
Dr. Ruy Machado Jr., Endometriosis Specialist
City: São Paulo, Brazil
Philosophy of Endometriosis Care: Believe mainly in the theory of cellular metaplasia and autoimmune theory.
What type of surgery do you perform for endometriosis: Excision
Medication: I often use medications; I often use dienogest and gossreline acetate. I use dienogest both before and after surgery to control symptoms. Gosserrelin acetate is used exclusively after surgery in cases of grade 4 endometriosis for a period limited to 6 months.
Approach to Persistent Pain After Surgery: I have been treating endometriosis for laparoscopy for 17 years and more recently for robotic surgery. In recent years, we have had very few patients with persistent symptoms after the surgeries we practice using nerve-preserving disease excision techniques. The cases we had improved only with the use of continuous dienogest, anti-inflammatory drugs, or the use of levonorgestrel IUD. Over these years, we re-operated only 2 patients for persistent symptoms.
Dr. Mauricio Abrao
Dr. Mauricio Abrao, Endometriosis Specialist
City: Sao Paulo, Brazil
Philosophy of Endometriosis Care: Immunology
What type of surgery do you perform for endometriosis: Excision
Medication: Oral contraceptives / dienogeste for patients with pain who don’t want surgery and
GnRHa 2m after surgery for patients with adenomyosis wanting to be pregnant
Approach to Persistent Pain After Surgery: US for mapping the disease
Dr. Daniel Santos
Dr. Daniel Santos, Endometriosis Specialist
City: Rio de Janiero, Brazil
Philosophy of Endometriosis Care: I believe in both the theory of retrograde menstruation and the embryonic theory as key explanations for the origin of endometriosis. These perspectives guide my surgical approach, leading me to perform a complete excision of endometriotic lesions and a full peritonectomy of the affected compartments to ensure thorough disease removal.
What type of surgery do you perform for endometriosis:Both excision and ablation. I always perform complete excision of endometriotic lesions, as I believe it is the most effective approach for disease removal. However, I reserve ablation for specific cases where excision is not feasible, such as extensive scattered diaphragmatic lesions and those located on the pericardium. In these situations, ablation is used to manage the disease while minimizing the risks associated with deep excision in anatomically challenging areas.
Medication: In my practice, I incorporate hormonal and non-hormonal medications as part of a comprehensive approach to managing endometriosis. I typically recommend hormonal therapy, such as combined oral contraceptives, progestins, or GnRH analogs, for symptom control in patients who are not candidates for surgery or who prefer a non-surgical approach. These therapies help suppress disease activity and manage pain.
For patients with significant pain, I use nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line symptom relief. Additionally, I may consider neuromodulators in cases of central sensitization and persistent pain syndromes.
However, in cases where surgery is indicated, I prioritize complete excision of endometriotic lesions. Postoperatively, hormonal therapy may be used to prevent recurrence, particularly in patients who are not seeking pregnancy. My treatment recommendations are always tailored to the patient’s symptoms, reproductive goals, and disease severity.
Approach to Persistent Pain After Surgery: This is a significant challenge, and unfortunately, it occurs with some frequency, especially when psychological factors are involved. My approach is always multidisciplinary, involving a pain specialist—my anesthesiologist, who is also a pain specialist and provides care at our clinic—along with pelvic physiotherapy and psychological support. This comprehensive strategy ensures that persistent symptoms are addressed holistically, considering both physical and emotional aspects to optimize patient outcomes.
Dr. Hebert Enrique Quintero Fajardo
Dr. Hebert Enrique Quintero Fajardo, Endometriosis Specialist
City: Barranquilla, Colombia
Philosophy of Endometriosis Care: The epigenetic theory
What type of surgery do you perform for endometriosis: Excision
Medication: Dienogest is used continuously in patients with superficial, ovarian, or deep endometriosis, with a reassessment of symptoms 12 weeks after starting treatment. Depending on the identification of other pain generators, additional medications may be incorporated, such as neuromodulators, muscle relaxants, antidepressants, and others.
Approach to Persistent Pain After Surgery: Given that patients with endometriosis experience multiple sources of pain, I conduct a thorough reassessment using a comprehensive, multi- and interdisciplinary approach. This approach addresses physical, nutritional, hormonal, and emotional aspects. Additionally, we evaluate pain centralization, assess potential recurrences, and review the recorded surgical footage to verify the complete excision of the affected tissue.
Dr. Andre Saute
Dr. Andre Saute, Endometriosis Specialist
City: Porto Alegre, Brazil
Dr. Alexandre Amaral
Dr. Alexandre Amaral, Endometriosis Specialist
City: São Paulo, Brazil
Dr. Anderson Pérez Muñoz
Dr. Anderson Pérez Muñoz, Endometriosis Specialist
City: Ibagué, Colombia
Dr. Raquel Reis Magalhães
Dr. Raquel Reis Magalhães, Endometriosis Specialist
City: São Paulo, Brazil
Dr. Monica Zomer Kondo
Dr. Monica Zomer Kondo, Endometriosis Specialist
City: Curitiba, Paraná, Brazil
Dr. Mariana Vieira
Dr. Mariana Vieira, Endometriosis Specialist
City: São Paulo, Brazil
Dr. Rodrigo Fernandes
Dr. Rodrigo Fernandes, Endometriosis Specialist
City: São Paulo, Brazil
