Hilgers, T. W. (2004). Chapter 70: PEARS: Peritoneal and Ovarian Endometriosis. In The Medical and Surgical Practice of NaProTECHNOLOGY (pp. 951-964).
Hilgers TW. Chapter 70: PEARS: Peritoneal and Ovarian Endometriosis. In: The Medical and Surgical Practice of NaProTECHNOLOGY. 2004. p. 951-964.
Hilgers, T. W. "Chapter 70: PEARS: Peritoneal and Ovarian Endometriosis." The Medical and Surgical Practice of NaProTECHNOLOGY, 2004, pp. 951-964.
For EndNote, Zotero or Mendeley:
License
No open license is recorded for this paper. Reuse terms are set by the publisher.
Author affiliations
1 institution
Pope Paul VI Institute for the Study of Human Reproduction, Omaha, Nebraska.027jqx654
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
PEARS surgery excises endometriosis and repairs the site smooth
PEARS surgery aims to remove pelvic endometriosis and repair the site to limit adhesions. A textbook chapter walks through the technique with photographs of surgical cases. The chapter reports no patient outcome data.
Key Findings
The chapter defines Pelvic excision and repair surgery (PEARS) as plastic reconstructive surgery of the pelvis. Its primary intent is to remove disease and repair the site so adhesions do not form.
For peritoneal endometriosis, the surgeon excises the lesion with a margin, controls bleeding, and closes the peritoneum with the edges turned inward so smooth tissue is exposed.
For a large ovarian endometrioma, the chapter says the complete endometrioma, including its capsule, needs to be removed. The chapter calls this extremely important for preventing recurrence in that ovary.
The chapter gives an operating time range of two to six hours, depending on the conditions treated.
The chapter describes irrigating the pelvis with the goal of completely clear fluid. Fluid that will not clear usually signals a small bleeding point to find and control.
Interpretation
PEARS treats endometriosis as disease to remove. Excising the lesion with a margin, then turning the peritoneal edges inward, clears the lesion and leaves smooth tissue behind. Smooth tissue helps prevent the adhesions that cause pain and recurrence. The same logic applies to the ovary. Removing the full endometrioma and its capsule protects that ovary from recurrence. The chapter describes the surgical technique. Outcome data on excision with adhesion prevention sit in other library records.
RRM Context
PEARS is the surgical approach of NaProTechnology. The approach pairs excision of endometriosis with adhesion prevention, so the disease comes out and the tissue heals smooth. Studies of excision surgery sit in other library records.
Our editorial summary of this paper, not the article's abstract.
Abstract
This chapter describes pelvic excision and repair surgery (PEARS), a form of plastic reconstructive surgery of the pelvis meant to remove disease and repair tissue without forming pelvic adhesions, as applied to endometriosis of the peritoneum and ovary. The technique uses a CO2 laser or micro-monopolar cautery to excise the diseased tissue and closes it with inert Prolene suture placed so that the edges invert and only smooth surfaces remain exposed. Serial operative photographs show excision from the anterior uterus and bladder, broad ligament, pelvic wall and cul-de-sac and removal of ovarian endometriomas, with the chapter stating that the complete endometrioma, including its capsule, needs to be removed to prevent recurrence in that ovary. The same ovarian closure is also shown after removal of a large endometrioma in a woman about 16 weeks gestation and after removal of a dermoid cyst.
027jqx654 