Doctors changing patients’ lives using endoscopic surgery
FOR the 10-15% of young women struggling with endometriosis, help is now available locally after two internationally trained specialists have opened an endoscopic surgery unit, dedicated to the treatment of the illness at Life St George’s Hospital.
“Endometriosis is a debilitating illness without a cure, but by using endoscopic surgery to remove the diseased tissue, 70% of our patients will not need another surgery, have a significant reduction in pain, a better quality of life and a much improved chance to get pregnant,” fertility specialist and gynaecologist, Dr Danie Botha said.
He has teamed up with colorectal surgeon Dr Emile Coetzee, to open the province’s first endoscopic surgical unit.
Botha said both he and Coetzee had developed a special interest in the treatment of endometriosis and had compiled a multi-disciplinary team to counsel and care for their patients.
The unit also has state-of-the-art equipment to remove the diseased tissue.
In the past, surgeons just cauterised the diseased tissue, necessitating several follow-up surgeries.
Botha said it was estimated that between 10 and 15% of all young women suffered from endometriosis.
“We do surgeries every week and for advanced stages of the disease, once or twice a month,” he said.
Botha said he believed that the majority of cases, however, remain untreated.
He said on average, it took between seven and nine years for a correct diagnosis, even though it had a devastating impact on a woman’s fertility and quality of life.
“By doing one big surgery, we remove the diseased tissue in 70% of cases,” Botha said.
He said in progressive stages of the disease, the colon was sometimes affected, which would require that a general surgeon be consulted as well.
When Coetzee, a dedicated colorectal surgeon, arrived in Nelson Mandela Bay, Botha took the opportunity to set up a dedicated unit.
“I think Emile had barely put down his suitcase and then we started working,” Botha laughed.
“There are only five dedicated centres in the country that can do this, and ours is one of them,” Botha said.
Coetzee said: “For us it is not only about the surgery. It is also about the pre-operative and post-operative care.
“Women normally get diagnosed when they have a fertility problem. They are then referred with a diagnosis or Dr Botha will make the diagnosis,” he said.
“Dr Botha will assess how serious the problem is by doing a CT scan and then refer the case to me.”
He and Botha would then devise the necessary treatment plan together.
Botha said if the urethra was affected, then urologist Dr Ernst Bonette would join the team.
The team have been working together for two years now and their staff have completed all the necessary training.
Botha said: “I think it is important for us to get the message out there that an advanced stage of endometriosis can be successfully treated.
“It is not necessary to get repeated surgeries that can become very expensive.
“We really want to help. Endometriosis really takes its toll on young women.
“It causes absenteeism at work or worse, even presenteeism [where the patient is present at work but unable to work due to severe pain]. We are getting closer and closer to a one-stop service to treat endometriosis,” he said.
Coetzee said before the unit was established, patients with an advanced stage of the disease had to be referred to Cape Town and Johannesburg for treatment.
Botha said: “We do procedures for endometriosis every week and we see progressive endometriosis once or twice a month.
“Often patients are not aware that they have a progressive illness that can be treated,” he said.
Coetzee said many patients, who actually had endometriosis, were initially diagnosed with irritable bowel syndrome.
“They are only helped when they get to a gynaecologist,” he said.
Botha said: “I think there are many women who do not even know that they are ill.
“They only find out when they have trouble getting pregnant.”
Botha said a study done at Tygerberg Academic Hospital found that where surgeons removed endometriosis through endoscopic surgery, 40% of women with the most advanced stage of the disease fell pregnant after six months.
“That is why we are here. We offer our patients the best chance they have. “It is not only another surgery.” He said most women had symptoms for seven to nine years before they were diagnosed with endometriosis.
“There are several advantages to endoscopic surgery,” Botha said.
“You can work behind the uterus. You can see very well as everything gets enlarged on the screen.
“There is very little scar tissue and adhesions and patients can return to work much faster.
“The procedure might be more costly but a quick recovery means the patient will have less hospital-related costs,” Botha said.
Coetzee said endoscopic surgery also had a much improved recovery period.
“We work from the premiss that a hospital is not the best possible place for a patient to recover, so it is our aim to see how quickly we can send patients home.
“We found that sending patients home faster, lead to fewer complications, better recovery and an earlier return to work.
“The cornerstone of enhanced recovery is to keep surgical trauma as low as possible.
“This is why endoscopic surgery works. As a surgeon I don’t have to move the intestines around.
“Even if we are doing extensive surgery, most patients can start eating the next day because their intestines still work.
“If you can’t eat or drink you need a drip and a hospital.
“It makes a big difference to the recovery of a patient and to the workload of the hospital,” Coetzee said.
Botha said a quick recovery was also essential to prevent blood clots.
“Many of our patients go home the next day. If we had to work on the colon, a patient will stay no longer than three or four days.
“It is important to me that our unit is on par with those in Amsterdam and England.”
Botha said the pain relief was also considerably better with endoscopic surgery.