Chapter 71: PEARS for Bowel Endometriosis: Surgical Techniques for the Gynecologist

Hilgers TW

Endometriosis Surgical Treatment

Chapter 71: PEARS for Bowel Endometriosis: Surgical Techniques for the Gynecologist

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 965-974, 2004

RRM Academy Synopsis

Gynecologic surgeons can excise superficial bowel endometriosis

A textbook chapter on pelvic excision and repair surgery (PEARS) explains that most gynecologic surgeons can excise superficial bowel endometriosis. They can also remove an affected appendix. Lesions that need bowel resection involve a general or colorectal surgeon.

Key Findings

Endometriosis of the terminal ileum, appendix, rectosigmoid colon, and anterior rectum is frequently missed at laparoscopy, and nearly all of it goes untreated outside centers dedicated to surgical treatment.
Superficial lesions of the terminal ileum, its mesentery, the cecum, and the rectosigmoid colon are excised with microcautery and repaired by serosal closure when the excision does not enter the lumen.
Anterior rectal nodules are excised with counter-traction and a two-layer closure of the muscularis and serosa; when the lumen stays intact, recovery resembles that after other PEARS procedures for endometriosis.
A negative sigmoidoscopy does not rule out anterior rectal endometriosis, most likely because most of these lesions do not penetrate the mucosa.

RRM Context

Pelvic excision and repair surgery (PEARS) is the surgical component of NaProTECHNOLOGY, developed by Dr. Thomas W. Hilgers. The surgeon removes endometriosis where it lies and applies adhesion prevention at the same operation. Suppressive medications hide symptoms while the disease progresses. Bowel involvement shows why a restorative approach places a thorough evaluation of the whole pelvis before treatment. Lesions that go undetected at laparoscopy remain a source of pain and may add to infertility.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes bowel endometriosis procedures that Hilgers considers within the capability of most gynecologic surgeons: appendectomy and excision of superficial lesions from the terminal ileum, rectosigmoid colon and anterior rectum. Hilgers states that in his experience endometriosis in these areas is frequently missed and almost always left untreated. The chapter recommends removing the appendix only when obvious or potential endometriosis is present and describes open and laparoscopic appendectomy techniques. For anterior rectal nodules, the chapter describes excision with counter-traction that often avoids entering the lumen, and reports that when the lumen is not entered, recovery is nearly identical to that of other PEARS surgery for endometriosis.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read

Topics

Endometriosis

Surgical Treatment Excision Surgery

Endometriosis › Surgical Treatment › Excision Surgery

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 71: PEARS for Bowel Endometriosis: Surgical Techniques for the Gynecologist

Gynecologic surgeons can excise superficial bowel endometriosis

Key Findings

RRM Context

Abstract

Read the guide

Topics

By this author

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