Re: Fibroids/endometriosis/adenomyosis
From: Elrod Darryl G MAJ 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL)
Sat Apr 9 03:52:48 2005
Dare I say TAH-BSO. I was trained the same way in that you need to see
the pelvis.
Glen
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
E. Siegel, M.D.
Sent: Saturday, April 09, 2005 3:45 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Fibroids/endometriosis/adenomyosis
Dan, there is nothing wrong with vaginal hysterectomy; I did one last
week for menometrorrhagia in a patient in her 40s who had
failed/couldn't take medical treatment, and had failed an ablation.
Long before LAVH, I was taught to go ABDOMINALLY for endometriosis.
Thus, in the patient about whom I posted this case, I propose that she
needs an abdominal component to her care. In comparing TAH-BSO to
LAVH-BSO, the latter is the lesser evil. A TVH-BSO would be an even
lesser evil, but it would not allow you to adequately assess the pelvis
and/or resect endometriosis.
Dan, I'm a traditionalist also, and we're on the same team. What did I
miss here?
How do you propose to assess the pelvis at TVH-BSO? Do you not think
that it is necessary?
For other listers, if this patient wished to go to surgery, how would
you do it? At 49, with endometriosis, I am going to assume that we all
would remove ovaries.
1. LAVH-BSO
2. LSH-BSO
3. TVH-BSO
4. TAH-BSO
5. Other way?
Garry
At Fri, 8 Apr 2005, R. Daniel Braun wrote:
>
>What is wrong with Vaginal Hysterectomy? Why do you feel the NEED to
>put a Laparoscope in the belly?
>VH has less morbidity than LAVH and is done with Same day surgery.
>Just because it is older doesn't make it less beneficial than
>something newer.
>
>Dan
>
>On Apr 7, 2005 11:52 AM, Richard Chudacoff, MD
><rchudacoff@mylinuxisp.com> wrote:
>> 1. Does she still have dysplasia? If not, then LSH is okay.
>> 2. Ablation is only 50-60 % successful, Mirena more. You asked or
>> non-surgical options, remember?
>>
>> Personally, if she has no evidence of dysplasia, then LSH, same day
surgery,
>> minimal morbidity...why not? If there is still evidence of dysplasia,
then
>> LAVH or LH.
>>
>> Richard Chudacoff, MD
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Garry E.
>> Siegel, M.D.
>> Sent: Thursday, April 07, 2005 10:25 AM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Re: Fibroids/endometriosis/adenomyosis
>>
>> Mirena after an ablation?
>>
>> LSH after a LEEP for dysplasia? If she comes to hyst, I would remove
the
>> cervix.
>>
>> Garry
>>
>> At Thu, 7 Apr 2005, Richard Chudacoff, MD wrote:
>> >
>> >Mirena, although I favor LSH
>> >
>> >--
>> >Richard Chudacoff, MD
>> >
>> >-----Original Message-----
>> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Garry E.
>> >Siegel, M.D.
>> >Sent: Wednesday, April 06, 2005 8:39 PM
>> >To: Multiple recipients of list OB-GYN-L
>> >Subject: Gyn: Fibroids/endometriosis/adenomyosis
>> >
>> >49 YO P2102 with:
>> >
>> >known fibroids--4 cm intramural/subserosal one seen at lapscope a
few
>> >years ago, still seen on scan and felt on exam
>> >
>> >Stage 2 endometriosis from same lapscope, excised totally
>> >
>> >S/P endometrial ablation for menorrhagia, done concurrently with
>> >lapscope. No fibroids in the cavity
>> >
>> >Also germane is that she has had a LEEP subsequent to the above for
CIN2
>> >(clear margins) with adenomyosis.
>> >
>> >Lastly, in college, she had a traumatic DVT and never has been on
the
>> >pill.
>> >
>> >She was seen in December with worsening menometrorrhagia and pelvic
>> >pain, and placed on Lupron. She has become amenorrheic, has no
pain,
>> >and says her abdomen is smaller (clinically she is around 8 weeks
size
>> >today, no real change).
>> >
>> >She is very troubled by hot flashes.
>> >
>> >Options I've kicked around:
>> >
>> >1. Increasing her Zoloft dose (already on 100 mg/day).
>> >2. Adding a progestin (which one? dose?).
>> >3. Add low dose combination estrogen/progestin therapy (remember
the
>> >DVT); if this is considered, might thrombophilia testing be in
order?
>> >4. Of course, LAVH-BSO, but for the sake of discussion, let's stick
to
>> >non-surgical options for now.
>> >
>> >Garry
>> >
>> >--
>> >Garry E. Siegel, M.D.
>> >Private Practice
>> >Roswell, GA
>> >
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
>--
>R. Daniel Braun
> Kinky for Governor
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
