- Mr. Trehan FRCS FRCOG is a specialist in the treatment of endometriosis. He has performed laparoscopic surgery for endometriosis for over 20 years, during which he has performed in the region of two thousand operations for endometriosis. Patients frequently travel to the United Kingdom from across the globe for endometriosis treatment with Mr. Trehan.
- Mr. Trehan does not agree with the widely held notion that endometriosis is an ‘incurable disease.’ Indeed, his practice has demonstrated that the effect of endometriosis on a woman’s life can almost always be reduced, if not eliminated through appropriate surgery.
- Mr. Trehan has innovated three surgical techniques in order to improve the outcome associated with endometriosis treatment surgery:
- Total Pelvic Peritoneal Excision – an extension of “conventional” excision surgery in order to reduce recurrence and improve outcomes after endometriosis surgery. After “conventional” excision, studies have shown that the chance of endometriosis returning (the ‘recurrence rate’) is approximately 30%-50%. However, Mr. Trehan’s data shows that the chance of endometriosis returning (the ‘recurrence rate’) after Total Pelvic Peritoneal Excision surgery by Mr. Trehan is less than 5%. Furthermore, even in the less than 5% of patients where recurrence occurs, it is very mild (minimal stage 1 endometriosis), and usually located outside the excision margin.
- Temporary Ovarian Suspension – to reduce the formation of ovarian adhesions (scar tissue which causes pain and infertility) after endometriosis surgery.
- Laparoscopic Post-Hysterectomy Vaginal Vault Excision – to treat patients with pain after a hysterectomy.
- Mr. Trehan performs all endometriosis surgery with no exceptions, no matter how advanced the endometriosis is (including endometrioma (chocolate) cysts, deep stage IV endometriosis, bowel/rectovaginal endometriosis and bladder/ureteric endometriosis), via laparoscopic (keyhole) surgery as it offers numerous advantages to the patient.
- Mr. Trehan never performs an oophorectomy (removal of the ovaries) in order to treat endometriosis, as he has demonstrated that thorough removal of endometriosis makes removal of the ovaries unnecessary. Further, removal of the ovaries is associated with numerous adverse health effects ranging from increased risk of heart attack to bone fracture to dementia. In the last decade, Mr. Trehan has never removed both ovaries in a patient with endometriosis.
- A hysterectomy is not the solution to treating endometriosis: if childbearing is desired and the uterus is not diseased, a hysterectomy can always be avoided. Mr. Trehan has demonstrated that a hysterectomy should only performed if childbearing is completed and the uterus is diseased (eg. adenomyosis), and even if a hysterectomy is performed, thorough removal of all endometriosis must still be performed.
- Mr. Trehan’s surgical complication rates and outcome results (in terms of symptom reduction and fertility) are shown below.
- The technical skill, operative experience and techniques used by the surgeon are the most important factors which determine the outcome of endometriosis surgery.
- Pain, menstrual, bladder and bowel symptoms are usually drastically reduced in the weeks-months following endometriosis surgery with Mr. Trehan. Further, these benefits usually last as shown by a recent long-term follow-up of Mr. Trehan’s endometriosis patients 3.5 years after Total Pelvic Peritoneal Excision surgery (without hysterectomy) with Mr. Trehan. These symptom scores are shown below, and were established by asking patients to fill in a questionnaire before their surgery to rate their symptoms on a scale from 0 (no symptoms) to 10 (extremely severe symptoms). This questionnaire was then repeated an average of 3.5 years after their surgery.
- In addition, 98% of patients experienced an increase in quality of life (average before operation: 2.7/10; average 3.5 years after operation: 8.2/10).
- Of patients under the age of 40 who were previously infertile/unable to conceive, 53% conceived naturally (without the need for IVF) after endometriosis surgery with Mr. Trehan. Note that even if IVF is needed, successful endometriosis surgery increases the chance of IVF success.
|Symptom||Average before surgery||Average after surgery||Average percentage reduction|
|Pelvic pain during periods||8.2||3.4||60%||Pelvic pain between periods||5.7||1.3||77%|
|Pain with intercourse||4.7||1.6||67%|
|Pain with opening bowels||4.8||1.9||60%|
- The table below shows Mr. Trehan’s surgical complication rates for common complications associated with endometriosis surgery.
- These figures are taken from an audit performed in 2012 of 169 consecutive private endometriosis patients undergoing Total Pelvic Peritoneal Excision (often alongside other complicated gynaecological procedures).
- These complication rates are amongst the lowest reported in the global medical literature for endometriosis surgery, despite many of Mr. Trehan’s patients having extremely complicated/severe cases of endometriosis requiring surgery lasting up to 9 hours, and around half having had at least one (sometimes as many as ten) previous failed, unsuccessful and abandoned operations elsewhere.
|Laparoconversion||Conversion to open surgery from keyhole surgery||0/169 (0%)|
|Ureteral lesions||Damage to the ureters (kidney urine tubes)||0/169 (0%)|
|Bowel perforation||Damage/puncture of the bowels||0/169 (0%)|
|Stoma – ileostomy or colostomy||Bowel ‘spout’ to direct faeces to exit from a hole the abdomen||0/169 (0%)|
|Faecal peritonitis||Internal leakage of faeces||0/169 (0%)|
|Sepsis or pelvic abscess||Severe infection||0/169 (0%)|
|Rectovaginal fistula||Abnormal opening between bowel and vagina||0/169 (0%)|
|Post-operative bleeding||Requiring another short procedure to stop the bleeding (no associated adverse consequences)||1/169 (0.6%)|
|Urinary retention (less than 7 days)||Short-term catheter tube to drain urine from the bladder||2/169 (1.2%)|
|Urinary retention (more than 7 days)||Long-term catheter tube to drain urine from the bladder||0/169 (0%)|
|Chronic functional bowel disturbances||Long-term problems with bowel movements due to surgery||0/169 (0%)|