QC: Surgical vs. Non-Surgical Endo Management: Risks, Tools & Truths With Dr. Jeff Arrington

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights. Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1:
0:41

Today I have an incredible expert joining us Dr Jeff Arrington. If you've spent any time in the endometriosis community, you've probably heard his name. Dr Arrington isn't just an excision specialist. He's a fierce advocate for informed consent and breaking down the barriers that keep so many from accessing proper endometriosis care. His passion goes beyond the operating room. He's fighting for real change, pushing back against misinformation and making sure that patients have the knowledge and options they deserve. Let's dive in. What's the best way to manage endometriosis symptoms if you can't afford excision?

Speaker 2:
1:17

Hard part, best way. I don't know if there's a best, best way. It's basically trying to find things that help each individual patient. I mean there's a bazillion hormones that can be used. Between all the different birth controls, progesterone-only medicines, iuds. There's the medicines that put you into menopause a slew of different hormones that patients can try Patients head to head. They're all proven about the same. Some patients may respond differently to others. I throw out a lot of other things that are very low risk. Some patients find benefits, some don't. So supplements like magnesium, omega-3s, turmeric, anti-inflammatory type things, anti-inflammatory diet, physical therapy, acupuncture, acupressure, and there's some places that do dry needling. There's a very number of things that patients can try that some get benefit from and some don't, but they're really low risk. I'm fortunate enough here in Utah to have a couple of really good chronic pelvic pain clinics I went at the University of Utah and one with Intermountain Healthcare for patients that really need a complex approach, medical approach, to pelvic pain. Those are nice resources for me to have.

Speaker 1:
2:30

Is there a connection between round ligament pain and endometriosis? And I think where this question came from is the correlation of round ligament pain specifically during pregnancy and then after pregnancy got worse until excision.

Speaker 2:
2:43

Not that I'm aware of. I can't think of a reason why they would be correlated, unless if there's endometriosis in the inguinal canal that could mimic around ligament pain. If there's really deep, thick endometriosis that's binding or shortening, pulling on the round ligaments, technically I guess that could give some pain, but not that I'm aware of.

Speaker 1:
3:01

What are the biggest surgical risks associated with deep excision?

Speaker 2:
3:06

I mean typical ones, deep excision, certainly bleeding. You have to be aware of where the blood vessels are, how to manage. We try to take really good care. Most of the endometriosis specialists are very good surgeons, very meticulous anatomists, and we're aware on how to avoid blood vessels. But sometimes that happens and you need to know how to manage stuff quickly.

Speaker 2:
3:26

Certainly injury to organs, either bowel, ureters or bladder, but again, most of us are very comfortable working around those and if there is an injury to the bowel or the bladder or the ureter, really the key is just getting it taken care of at the time of surgery and as long as we do that at the original surgery, the risk of complication afterward is really low. It's the unrecognized ones that are problematic. Really, over the last 10 years or so we're learning a lot more about the pelvic nerves and we used to go in and just cut away at will. But having a better understanding of the hypogastric nerves and the splenic nerves for bladder and bowel function, those are fairly high risk for deep excision, just because some of the common areas for deep endometriosis are the pararectal areas in the uterus, sacral ligaments, and that's right where all those nerves run, and so we have to really be aware of those nerves, what their functionality is, and do our best to preserve as much as we can.

Speaker 1:
4:18

Also is there more risk with deep endometriosis, with ureter involvement without proper care being severed. The ureters being severed.

Speaker 2:
4:31

Oh yeah, surgery done by an endometriosis specialist. Probably I would have to look it up but I would put money on that. We have a much lower complication rate than regular gynecologists doing regular things. There are more. It's more common to have a ureter injury from just a straightforward common hysterectomy than it is for an excision specialist doing complex deep endometriosis work.

Speaker 1:
4:55

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.