Vimee Bindra, M.D., Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
City: Hyderabad, Telangana, India
Philosophy: Theory of Mulleriosis as proposed by Dr. David Redwine. The disease cells are laid down during the development of the Mullerian system and are triggered by various factors in the aging process and due to abnormal differentiation of the Mullerian duct system.
Medication: Endometriosis is a whole-body disease and there is no cure to date and excision is the first-line treatment or akin to cure for endometriosis. Our approach to endometriosis is holistic and the patient is involved in decision making.
As medical therapy does not work for endometriosis we don’t recommend it pre-operatively but post-operatively we rely on progestin-based therapies specially dienogest or hormonal contraceptives and Mirena IUD for adenomyosis. The medical therapy post-operatively is tailored to the patient’s age, diagnosis (endometriosis and adenomyosis and associated pathologies like fibroids and PCOS), needs, desire for fertility, and if the patient is scheduled for assisted reproduction treatment (patients undergoing IVF) if any.
Pain mediations and narcotics as and when patients need them.
Approach to Persistent Pain After Surgery: Our patients are followed up at 3, 6, 9, and 12 months post-operatively for all pain generators or until they are doing well. All our post-operative patients are started on an anti-inflammatory diet and pelvic physiotherapy.
There can be several pain generators other than endometriosis we need to look for them with the help of a pain specialist and sometimes patients may need nerve blocks or local blocks for pain.
Evaluation for residual disease or recurrence, if operated outside its difficult to differentiate between recurrence and residual disease but in our post-operative patients we do that, and chances of repeat laparoscopy are less than 10 % in our practice.
All post-operative patients are routinely advised anti-inflammatory diet and pelvic physiotherapy.
Medical therapy specially progestogen-based therapies.