Monday, October 26, 2009

Laparoscopy for Pelvic Adhesions

Laparoscopy for Pelvic Adhesions

Pelvic adhesions (scars) develop as a normal tissue response to inflammation, which occurs whenever the tissue is damaged. Infertility surgeons make every attempt to limit or prevent pelvic adhesion formation following laparoscopy or laparotomy, and an experienced fertility surgeon may be able to significantly reduce the bulk of previously formed pelvic adhesions through meticulous care at laparoscopy.

Ideally, infertility surgery adheres to the principles of “microsurgical technique,” a set of surgical methods designed to reduce adhesion formation. Crush injuries to tissue can result in scar formation, so very gentle tissue handling is encouraged. Blood is very irritating to the lining cells overlying the pelvis, called peritoneum, so thorough control of even small amounts of bleeding and removal of any blood collected in the pelvis and abdomen is important. Identification of the proper tissue planes is important in order to avoid surgical damage to the tissues that are being separated so magnification should be available when needed. Tissues that dry out become damaged much more easily than tissues that are kept moist, and it is much easier to maintain adequate tissue moisture during laparoscopy as compared to laparotomy since the abdomen is essentially closed during the laparoscopy procedure. Infection should be avoided (and if inevitable then infection should be treated as early as possible) since a pelvic infection can rapidly destroy the very delicate reproductive tissues. Carbon deposits or char caused by the use (or overuse) of cautery to burn or sear abnormal tissues or control bleeding can result in adhesion formation and should be minimized whenever appropriate. Devascularization of tissue or ischemia can result from burn injuries that damage the blood vessels feeding tissues, so use of the ultrapulse CO2 laser is ideal for many infertility laparoscopy procedures since this tool allows vaporization of unwanted tissue with minimal lateral thermal damage to surrounding tissues.

Dr Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has personally performed over a thousand laparoscopy surgeries using the ultrapulse CO2 laser for the treatment of pelvic adhesions during the past 20 years. He would be happy to help you. Contact the office at 908 226 0250 for an appointment. Also, visit us on the web at or

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Tuesday, October 13, 2009

Female Pelvic Pain

Female Pelvic Pain

Most women will occasionally have some sort of pelvic pain, which can be alarming. Pelvic pain can be caused by many different problems, most of which are transient (short lived and resolve spontaneously). Some causes of pelvic pain represent ongoing long-term problems within the pelvis, most of which can be successfully repaired.

The sudden onset of moderate to severe female pelvic pain during the reproductive years can be caused by gynecological, gastrointestinal, urological or musculoskeletal problems. Gynecological problems include menstrual cramps, pelvic endometriosis, ovarian cysts, degenerating fibroids, pelvic infections, pelvic adhesions (scar tissue), and pregnancy (including ectopic pregnancy). Temperature with a thermometer, a pregnancy test, and bouncing on the heels to gently jar the abdomen can suggest the cause. Any history of fever, positive pregnancy test, or generalized pelvic pain with bouncing on the heels should be reported to your Gynecologist immediately. If there are problems with nausea, vomiting, diarrhea or other intestinal symptoms then you should report this to your primary doctor or Gastroenterologist. If there are problems with urination or bloody urine then this should be reported to your primary doctor or Urologist. If there are problems with moving your legs or back then you should report this to your primary doctor or Orthopedic doctor.

Sometimes the female pelvic pain will last for longer periods of time, such as several months or years. When this is the case, gynecological problems such as endometriosis, pelvic adhesions, persistent nonfunctional ovarian cysts and fibroids are common causes. When the discomfort reaches a level where further investigation and treatment is desired, then a laparoscopy should be considered. Finding an experienced laparoscopic surgeon, and ideally finding a Reproductive Endocrinology and Infertility doctor with specialization in pelvic repair, often allows effective treatment to be completed with only one minimally invasive day stay surgery (laparoscopy).

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with laparoscopy and pelvic repair. He would be happy to help you. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at

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Monday, December 31, 2007

The Pain of Endometriosis

Endometriosis is a condition where tissue found in the lining of the uterus attaches to organs and other areas outside the uterus. It is thought to occur in 10-20% of women between the ages of 20 and 45. While the cause of endometriosis is still unknown, there is a relationship between hormone estrogen and immune system dysfunctions.

During a women’s menstruation the lining of the uterus bleeds and sheds and is forced out of the uterus by small uterine contractions. Uterine tissue, called endometrium, that is shed makes its way into the pelvic cavity. This is referred to as retrograde menstruation. This displaced tissue may then implant on the ovaries, fallopian tubes, and on top of the uterus or its supporting ligaments. Other areas of occurrence are the abdomen, the area between the vagina and rectum, bowel, bladder, vagina, cervix, vulva, and in abdominal surgical scars. In rare circumstances they can be found in the lungs, arms, or thighs.

Women who suffer from endometriosis have been found to have excess levels of estrogen in their system. Studies have proposed that women with excessive levels of estrogen are at higher risk for endometriosis. This is because estrogen stimulates cell growth. Normally, the immune system is able to take care of any endometrial tissue that finds its way in to the pelvic cavity via retrograde menstruation. However, high levels of estrogen counteract the body’s ability to cope with the invading tissue. The immune system is overwhelmed and the implanted tissue grows and flourishes. This tissue will continue to respond to the hormonal cycle, and the shedding and bleeding causes inflammation and scarring.

One difficulty in diagnosing endometriosis is that the symptoms mimic several other medical conditions, such as ovarian cysts, pelvic inflammatory disease, ovarian cancer, colon cancer, fibroid tumors, or irritable bowel syndrome. The most common of endometriosis symptoms is pain. However, some women may experience no symptoms at all. Other symptoms include pain in the abdomen and lower back associated with the changes occurring during the menstrual cycle, pain experienced during intercourse, heavy or irregular periods, painful bowel movements and urination, diarrhoea or constipation, fatigue, and general chronic pain at any time. Additionally, endometriosis will cause infertility in 40% of women affected.

Treatment of endometriosis is the subject of some controversy, as the exact causes of the condition are unknown. Some treatments may focus on eliminating or reducing the amount of estrogen a woman’s body produces. Laparoscopy is a common infertility treatment when endometriosis affects a woman’s ability to become pregnant. Less obtrusive treatments suggest changes in diet and exercise routine, thereby strengthening the body’s muscles and immune system which help the body naturally fight the condition.

About the Author:

Eric Daiter has been sponsored by The NJ Center for Reproductive Medicine, a leading provider of infertility treatment, to write information about endometriosis symptoms. For more information, please visit

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