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Manipal Hospitals, Goa, successfully performs surgery on a case of advanced deep infiltrating endometriosis

A 39-year-old patient with the rare condition benefited from the successful surgery



Goa, April 25, 2023: Surgeons of Manipal Hospitals, Goa, successfully performed a very complicated and rare surgery on April 16, 2023 on a 39-year-old woman suffering from advanced deep infiltrating endometriosis, which is a chronic painful disease affecting women of the reproductive age group. The disease had spread to both the ureters of the woman, threatening to damage her kidneys by causing blockages and also to the bowel and other vital structures like tubes and ovaries.

Due to the patient’s previous three surgeries, many episodes of endometriotic ascites, peritonitis, sub-acute bowel obstruction, and the advanced and complex nature of the disease, she was refused surgery by multiple doctors and hospitals. The patient ran from pillar to post only to be advised of a hysterectomy, i.e. removal of the uterus, and that too at a centre outside Goa. However, the patient, who was infertile, was keen on having a child through medical means, such as In Vitro Fertilisation (IVF).

The case was finally taken up by Dr Mohammed Afzal Siddiqui, Consultant Laparoscopic & Robotic Gynaecological Surgeon at Manipal Hospital, Goa. The patient underwent successful laparoscopic adhesiolysis (removal of urinary bladder/bowel/uterine/ovarian adhesions), bilateral ureterolysis (removal of endometriotic nodules to relieve block of the kidneys), bilateral ovarian endometriotic cystectomy (removal of ovarian chocolate cysts – ovaries preserved), bilateral round ligament excision, appendectomy, adenomyoma excision and large bowel resection anastomosis (removal of the diseased large intestine segment and re-joining of the intestine) at Manipal Hospital, Goa, by Dr. Mohammed Afzal Siddiqui, Dr. Vivek Salunke, and a team of doctors.

Not only did the surgeons manage to save the patient’s kidneys, but also saved both her ovaries and reconstructed the uterus after adenomyoma excision and removal of all diseased tissue, so that she could undergo future fertility treatment in the form of IVF. All this was achieved laparoscopically and the patient is now recuperating well at home.

Dr Mohammed Afzal Siddiqui, Consultant Laparoscopic & Robotic Gynaecological Surgeon at Manipal Hospital, Goa, said, “Such cases of advanced endometriosis which infiltrates the bowel, ureters, and extra pelvic structures are very rare and operating on them is a surgical challenge requiring advanced surgical training, hi-tech instruments, and a multi-disciplinary team. Not only did we manage to save the kidneys of the patient, and also resect the blocked bowel segment but we also managed to preserve both her ovaries and reconstruct the uterus after adenomyoma excision and removal of all diseased tissues, so that she can undergo future fertility treatment, such as IVF. Most hearteningly, all this was achieved through laparoscopic surgery. It gives us great joy and satisfaction to say that the patient is now recuperating well at home.”

Commenting on the success of the surgery, Mr Surendra Prasad, Hospital Director, Manipal Hospitals, Goa, said, “I congratulate the entire team for the intricate diagnosis and treatments provided, thus giving a better quality of life for the patient. Manipal Hospitals, Goa, has an expert panel of highly-qualified full-time super-specialty consultants, who often work together on complex cases with a very scientific and disciplined approach. Dr Mohammed Afzal Siddiqui is trained to operate on advanced deep infiltrating endometriosis involving the ureters, bowel, etc. Manipal Hospital, Goa is fully equipped to perform such complex and challenging cases, offering women suffering from this dreaded disease a chance to have their own children in future or get permanent relief from their symptoms through laparoscopic surgery.”

“This patient benefitted immensely from the well-coordinated multi-disciplinary approach and excellent support given by our well-trained nursing staff as well as clinical assistants,” Mr. Prasad added

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