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.