Dr. Carlos Enrique Parraga Sandoval, Endometriosis Specialist
City: Lima, Lima, Peru
Philosophy of Endometriosis Care: Consider that genetic and epigenetic theory play a crucial role in the pathophysiology of the disease. – Over time, endometriosis has had a wide variety of options as part of its development. However, the lack of a concise and clear definition makes each patient’s management and future treatment completely different. -For example, it is crucial to consider the onset of endometriosis with extensive organic involvement versus endometriosis with isolated nerve involvement. – This makes part of my management personalized. Most of my patients who come for a new medical opinion or surgery have highly relevant medical histories: previous surgeries, family history of endometriosis, and persistent pain.
What type of surgery do you perform for endometriosis: Excision
Medication: The vast majority of my patients receive a combination treatment, which includes hormone suppression therapy, an anti-inflammatory diet, and vitamin supplements. -In some cases, we resort to excisional surgery for endometriosis. Afterward, we continue the treatment, which is discontinued when the patient desires pregnancy or is in menopause. -I also incorporate pain relief, especially for patients with injuries to the pudendal nerve or peripheral branches of the ilioinguinal or iliohypogastric nerve. -I generally recommend treatment independently of surgery. If surgery is required, we continue treatment afterward and evaluate pain improvement over the months.
Approach to Persistent Pain After Surgery: A large number of patients who come for a second opinion because they persist in pain despite undergoing surgery. It is important to mention that patients need:
1) A new evaluation of the type of pain they have and a determination of whether it is due to endometriosis or another pelvic cause. Previous studies and treatments must also be evaluated.
2) A neuropelviological perspective must be considered, not only to view pain as a disease but also as information, and to evaluate the pain pathway, given that a large number of patients have nerve involvement.
3) A coadjuvant treatment must be considered for pain management: pelvic physical therapy, pain therapy, among others.