Doç. Dr. Cengiz ANDAN
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Endometriosis (Chocolate Cyst disease), which we frequently encounter in gynecological practice, progresses with very different clinical pictures from person to person. While it appears as a simple cyst in the ovary in some patients, in others, it can take on a form as deep and destructive as the invisible face of an iceberg. In medicine, this clinical picture is called Deep Infiltrating Endometriosis (DIE).
This condition usually lies behind those severe pains that ordinary painkillers, birth control pills, and temporary solutions cannot help; pains that turn the patient’s social life, work life, and psychology upside down.
As Assoc. Prof. Dr. Cengiz Andan, our aim in the treatment of this disease, which requires advanced laparoscopic surgery experience, is not only to remove the cyst but to return the patient’s life to her by cleaning all deep foci causing pain.
What is Deep Infiltrating Endometriosis?
It is the condition where endometriosis foci descend deeper than 5 millimeters from the surface of the peritoneum (membrane lining the abdominal cavity) and penetrate into the tissues. This form is the most aggressive and most painful type of the disease.
While foci are like a “stain” in superficial endometriosis, these foci take the form of hard “nodules” in deep endometriosis. These nodules can involve not only the uterus and ovaries but also the intestines, urinary bladder, urinary tracts (ureter), and the space behind the uterus. It disrupts anatomy by gluing organs together just like a strong adhesive. In medical literature, this situation is called “Frozen Pelvis”; internal organs become immobile due to adhesions, and every movement creates severe pain.
Which Symptoms Point to “Deep” Endometriosis?
Our patients usually come with the complaint, “I have been suffering from pain for years, but nothing can be found.” This is because deep nodules can sometimes be missed in routine ultrasounds. If you are experiencing the following symptoms, the probability of deep infiltrating endometriosis is high:
The Gold Standard in Treatment: Advanced Laparoscopic Surgery
Deep infiltrating endometriosis is not a disease that can be completely eliminated with medication. Medication only suppresses it. The definitive solution to the disease is the surgical removal of the nodules. However, this surgery is much more complex and sensitive than a standard cyst surgery. Deep endometriosis surgery requires advanced laparoscopy (closed surgery) experience and anatomical mastery.
The surgical strategy we apply in our clinic is as follows:
A New Life After Surgery
The sentence most frequently established by patients after successful deep endometriosis surgery is: “I feel like I’ve been reborn.”
It is observed that pains decrease by 80-90% or end completely. Additionally, since the anatomy of the organs is corrected and adhesions are opened, the chance of spontaneous pregnancy increases significantly.
Remember; endometriosis is not just a “woman’s disease,” but a condition that affects the entire body and soul. You do not have to live with these pains. Correct surgery performed by the right hands opens the door to a painless future.
It is difficult to see with a standard abdominal ultrasound. However, deep nodules can be detected in a vaginal ultrasound performed by an experienced eye and especially in Pelvic MRI imaging. The physician’s experience is more important than the device in diagnosis.
This is the biggest fear of patients. In 95% of cases, there is no need to take the intestine out (attach a stoma). The nodule is cleaned, or that part of the intestine is removed and connected end-to-end. A temporary stoma may be opened very rarely, in very advanced and risky cases, to secure the healing process (for a few months), but this is a very low probability.
Deep infiltrating endometriosis surgeries are the most challenging surgeries in gynecology. Depending on the prevalence of the disease and the organs involved, the operation time can vary between 2 hours and 5-6 hours. The important thing is not the time, but the meticulous cleaning of all foci.
Generally, it is recommended to wait 2-3 months for the tissues to heal after surgery. Afterward, since the anatomy is corrected, the patients’ chance of pregnancy naturally or with IVF is much higher compared to before surgery.
Open surgery can be done, but it is not recommended in modern medicine. Laparoscopy (closed method) provides the surgeon with a 10-15 times magnified image. In this way, millimetric nerves and vessels can be protected, and nodules are seen more clearly. Also, the risk of adhesion after closed surgery is much less compared to open surgery.