Mr. Trehan FRCS FRCOG | Endometriosis Specialist

  • 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 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 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 endometriosis surgical complication rates are amongst the lowest reported in the medical literature and 90% of his patients leave the hospital after just one night’s stay following surgery, despite many of his patients having the most complicated cases of endometriosis and around half have had at least one (sometimes as many as ten) previous failed, unsuccessful and abandoned operations elsewhere.

Outcome results

  • The technical skill, operative experience and techniques used by the surgeon are the most important factors which determine the outcome of endometriosis surgery.
  • Mr. Trehan has presented his outcome results for Total Pelvic Peritoneal Excision across the globe at medical conferences, most recently at the 2014 World Congress on Endometriosis in Brazil.
  • 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 – a recent long term follow up of Mr. Trehan’s endometriosis patients found that 3.5 years after Total Pelvic Peritoneal Excision surgery (without hysterectomy) with Mr. Trehan:
    • Pelvic pain was on average 78% lower than before their initial operation
    • Backache was on average 70% lower than before their initial operation
    • Pain with intercourse was on average 67% lower than before their initial operation
    • Bowel pain was on average 60% lower than before their initial operation
    • Bladder problems were on average 73% lower than before their initial operation
    • 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).
  • Following endometriosis surgery with Mr. Trehan, of patients under the age of 40 who were previously infertile, 53% conceive naturally (without the need for IVF). If IVF is needed, successful endometriosis surgery increases the chance of IVF success.