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.