This patient is a 28-year-old from California who has never been married and has no children. She has complained of pelvic pain due to endometriosis and adhesions. She has had multiple abdominal and pelvic surgeries for endometriosis and adhesions as well as ovarian cysts in the past. Previous surgery resulted in the loss of both of her ovaries. She is here to see Dr Miklos for adhesion surgery and endometriosis. Dr Miklos decided to consult endometriosis specialist Dr Jeffry Arrington to co surgeon the operation. They both felt that the patient would benefit from a hysterectomy as examination confirmed central chronic pelvic pain.
A laparoscopic approach (Figure 1) was utilized and adhesions (Figure 2) were taken down without complications. After Dr Miklos removed adhesions then Dr Arrington stripped out endometriosis off the uterosacral ligaments bilaterally.
Dr Miklos explained to the patient that adhesions are difficult to assess as the cause of pain and there is not diagnostic tool without going to surgery. In other words: no x-ray, CT scan, ultrasounds or MRI can tell us if adhesions are present. One must do surgery to determine if the adhesions exist and concurrently takedown the adhesions to see if doing see helps with pain relief.