Endometriosis is a very common cause of pelvic pain and can also cause infertility. It can lead to quite a debilitating illness in some women, causing severe scarring and damage to pelvic organs. It is a condition where there is tissue similar to the uterine lining (endometrium) – which produces the menstrual blood – being present outside the uterus in the pelvis where it shouldn’t be. Therefore this tissue can flare up and “bleed” internally every month, causing severe inflammation and damage. It is commonly found deep down in the pelvis near the vagina and bowel but can also affect ovaries, tubes and other organs. Ultrasound might help in the diagnosis but ultimately diagnosis is made by visualising it at keyhole surgery with laparoscopy. It may present with many different appearances and can be a lot deeper than is initially thought (Deeply Infiltrating Endometriosis). Other delicate organs such as bladder and bowel can be involved, and scarring (adhesions) can occur. Therefore it is most important that an experienced specialist in this disease assesses the pelvis carefully and systematically. Treatment must then be performed thoroughly and completely, carefully freeing organs ensuring that all areas of endometriosis and scarring are completely removed. As a highly experienced laparoscopic surgeon, Dr Marshall recognises all the different forms of endometriosis and ensures thorough treatment.

The natural history of endometriosis is that it will tend to get worse with time. Treatment is most successful the earlier it is done. It is most important that any woman with significant pelvic pain should be referred for assessment for the possibility of this disease.

Treatments and procedures

Treatment can be with hormonal/ medical therapies or surgery. Hormonal/medical therapies can be expensive and unfortunately can have quite a few side effects. Surgery is the most effective treatment and can be done at the time of diagnosis via laparoscopy. Treatment should be completely performed at the first laparoscopy to get the best results and avoid the risks of repeat surgery. Therefore any woman undergoing laparoscopy for investigation of pelvic pain or infertility should have an experienced subspecialist in laparoscopic surgery to perform her laparoscopy. Dr Marshall is a recognized specialist and consultant in advanced laparoscopic surgery and uses CO2 laser excisional surgery as well as other modalities. He performs his surgery with microsurgical principles ensuring careful handling of the tissues, meticulous haemostasis, efficient surgical technique and adhesion prevention principles. His care and safety record are excellent. His complication rates are lower than the reported average.

For severe complex endometriosis, particularly involving bowel, he operates as part of a team, with a laparoscopic colorectal surgeon and another advanced laparoscopic gynaecologic surgeon.

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