Women’s Health – Endometriosis

Laurence Orbuch,MD
Laurence Orbuch,MD

Dr. Laurence Orbuch is Board Certified Obstetrician/Gynecologist and Medical Director of GYN Laparoscopic Associates in Los Angeles California. He specializes in the treatment of Endometriosis and is one of a handful of specialists in this field in the United States.

Endometriosis is a condition where there are implants of tissue that resemble the cells found in the endometrium (lining of the uterus), outside of the uterus. These cells are stimulated in the same way that the endometrium is monthly, and the same release of blood and inflammatory and other mediators occurs on or within the structures these implants are located. This then triggers a cascade of inflammation and stimulation of nerves and central nervous system which results in a myriad of symptoms that can be cyclic (related to menses) or acyclic (unrelated to menses). The symptoms tend to become progressively worse and involve other organ systems, such as the gastrointestinal tract, urinary tract, etc.

My approach is a more holistic and mind-body approach, as by the time I am evaluating these patients they have been suffering for years if not decades. All of the co-existing conditions and pain generators must be addressed in addition to performing the proper surgery. I also perform Endometriosis excision surgery NOT ablation surgery. The difference is that with excision, you are actually cutting out and removing the disease, whereas ablation, or fulguration, burns the surface of these lesions and doesn’t remove them. It also doesn’t allow you to see the depth of the lesion and whether or not the entire implant was eradicated. In addition, ablation results in scar tissue, adhesions (adjacent structures potentially being adherent to the burnt surface), and frequently more pain because the burning triggers more pain signals to the central nervous system. Excision surgery also has roughly a 10% recurrence rate vs. ablation which has over 35% recurrence rate. I am also a proponent of the movement to diagnose these patients earlier in life, and put a dent in the staggering statistic that most people experience an average of a ten-year delay to diagnosis.

You listen to Dr. Orbuch and Mark here:

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