How to prevent fibrosis from recurring
Female, 28 years old, and I’ve had three laparoscopic excision surgeries now to remove endo in the last two years. Last surgery was in May and also included a presacral neurectomy. So far the pain relief has been significant and I’m almost back to my old life!
One thing that worries me is that at my last two surgeries, there was a significant amount of fibrosis on my previous sites of endo. It was most notably the rectovaginal area, left ovary, right uterosacral ligament, paracervical area, and bladder. At my third surgery, there was so much fibrosis on my left ovary that it adhered my ovary to my pelvic side wall.
Is there a way to prevent fibrosis from growing back? My doctor is wonderful (Dr. Ted Lee), and I’m simply amazed at my life post-surgery, but I’m honestly worried about how fibrosis even got that bad in my case.
- Maria Rovito asked 11 months ago
- last edited 11 months ago
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Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:
There is some good news to discuss here, but the bad news is that your body NORMALLY heals using fibrosis and scarring as a natural healing mechanism to injury. So, to some extent it is totally normal. In some people, fibrosis or scarring is more pronounced; in others, there may be no or minimal thin adhesions, which are on the lower end of the fibrosis scale. That can be related to surgical technique, tissue oxygenation, and cellular molecular pathway differences (based on genetics). This varies between people and can predispose towards more or less scarring. Individual precision medicine measures will be possible based on molecular testing targets in the future, but we are not there yet.
The surgical technique itself does contribute to scar formation. More meticulous and less traumatic surgery, with less cautery, theoretically leads to less scar. However, you had a master surgeon operate in your case and still ended up with fibrosis. So, a better surgical technique does help but is not the complete answer.
In general, reliable prevention of adhesions and fibrosis has been elusive. However, this is one reason to seek a master surgeon. While bad surgical technique may not have been the cause in your case, it certainly is in other cases where burning, slashing, and tearing in the hands of novice or mediocre surgeons leads to more scar-producing trauma.
Minimally invasive surgery generally leads to fewer adhesions and fibrosis than open incisional surgery. There is some research evidence that robotic surgery may be less traumatic than laparoscopic surgery, at least in some cases. This may be due to the ability to more gently and meticulously handle tissue using precise robotic instrumentation. Prevention of inflammation through less trauma, less blood loss, and less cautery use helps as well. These and other techniques that master surgeons use may reduce adhesions and fibrosis.
Numerous biological barriers and pharmaceutical approaches have been introduced over the years to reduce scarring, adhesions, and fibrosis. In addition, integrative holistic approaches such as perioperative Bromelain hold some promise. There is no clear winner to date, and various measures are used by different surgeons. But there is some reason to believe that the more the surgeon does to reduce inflammation, improve local oxygenation of tissue and improve local lubrication using perioperative measures, the less fibrosis may result. Suffice it to say that a meticulous master surgeon who studies the molecular causes of fibrosis and adhesions and applies reasonable counter-measures to reduce scarring may get you the best results.
For others reading this, beyond the excision part of endo surgery, this is also how an expert can improve your outcomes over average surgeons who do not specialize in endo.
*This is not medical advice and is aimed for informational use only. Please contact the doctor’s office or consult with your doctor for any medical questions.
- Dr. Steve Vasilev answered 10 months ago
- last edited 10 months ago
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