Kenneth I. Barron, Gynecology & Minimal Invasive Surgery, Endometriosis Specialist.
City: Charlottesville, Virginia
Philosophy:
Endometriosis is the medusa of gynecologic care. It is a many-headed monster with evidence of disease from birth (congenital); spread through vascular and lymphatic channels; metaplasia; and efflux of menstrual tissue. The origin is less important than the disease location, symptoms, and treatment goals. I treat endometriosis much like cancer: It must be resected with wide margins as recurrences when they occur, are typically in the same locations as previous disease.
What type of surgery do you perform for endometriosis?:
Excision
Medication:
Hormonal medications can be helpful in patients for controlling symptoms, preparation for fertility treatment, and anticipation of surgery. Patients seek me out for surgical management when medicine fails. I often have patients try high-dose progesterone (norethindrone at 2.5 mg) if they have not before. I occasionally treat with GnRH antagonists in cases of nerve involvement, desire to shrink disease before operating to reduce the risk of oophorectomy, and prolonged waiting for surgery.
Approach to Persistent Pain After Surgery:
I always continue to take care of my patients after surgery. There can be more than one pain generator co-existing with endometriosis. If pain persists post-operatively I re-evaluate the patient for other sources of pain, if not already recognized pre-operatively, such as myofascial pain, neuropathic pain, primary uterine pain, bowel and bladder-related pain.