EFA Medical Conference 2017: "Endometriosis: hormonal or surgical? My reality!" Presentation by Dr. Harry Reich

Dr. Harry Reich talks about surgical techniques and tools that can be used in the treatment of endometriosis.

Key Points

Highlights:

• Dr. Harry Reich, the Former Director of Advanced Laparoscopic Surgery at Columbia University Department of OBGYN, gave a presentation at the EFA 2017 Medical Conference. He talked about surgical treatment of endometriosis. He also discusses the biased priorities of the American Congress of Obstetricians and Gynecologists and big Pharma.

Importance:

• Surgical treatment of endometriosis can be complicated - thus it is in the best interest of the patient, and the surgeon is trained exceptionally well and can efficiently operate on the diseased areas.

Key Points:

• Dr. Reich is skeptical that endometriosis therapy could be hormonal. He is also doubtful that retrograde menstruation plays any part in endometriosis development. He argues that cases of endometriosis caused by retrograde menstruation, not attached to the peritoneum, would be able to be removed with a suitable suction irrigator.
• Dr. Reich believes endometriosis is present from birth, caused by the scattering of cells trying to find their way into the uterus.
• Endometriosis is always surrounded by fibrosis.
• Endometriosis is not malignant.
• A pelvic pain exam must be accompanied by a rectal examination. Rectovaginal examinations are the most critical tool.
• All the endometriosis lesions should be removed, no matter it results in the resection of countless specimens.
• The progression of endometriosis surgery:
  • Dr. Robert Kistner used to do diagnostic laparoscopy using Pfannenstiel's incision or Pfannenstiel incision laparotomy. But he did not explore the cul-de-sac.
  • Once the cul-de-sac scrutinized, endometriosis surgery was significantly improved.
  • Before the beam and splitter, surgery was conducted using the surgeon’s eyes.
  • The only manipulator needed for the uterine cavity is a simple curette.
  • One of the most important innovation for endometriosis surgeries was to insert a probe into the rectum and a sponge behind the cervix.
  • At the end of the operation, Dr. Reich would put 2,000ml Ringer's lactate within the peritoneal cavity.
  • Dr. Reich uses simple scissors, carbon dioxide lasers, spoon electrode cutting current, rectal probes, and circular staplers.
  • Fixing holes in the rectum is straightforward.
• The American Congress of Obstetricians and Gynecologists and big Pharma do not prioritize the well-being of women with endometriosis, and Dr. Reich urges those who support such institutions to the embargo.

Lay Summary

Dr. Harry Reich, the Former Director of Advanced Laparoscopic Surgery at Columbia University Department of OBGYN, was the last speaker in the Mission and History part of the EFA 2017 Medical Conference. His presentation was titled “Endometriosis: hormonal or surgical? My reality!”

Dr. Reich’s presentation delves into his perception of what causes endometriosis. Dr. Reich is skeptical that the disease is caused by retrograde menstruation. He has a much more disease-oriented view. He argues that small cells are trying to make it into the uterus, but are scattered when they are unable to achieve this goal. Dr. Reich discusses the evolution of surgery as it pertains to endometriosis. He states that endometriosis surgery got much better once laparoscopy started attacking the cul-de-sac. Dr. Reich then delves into his surgical practices. He is a tremendous proponent of using simple scissors, spoon electrode cutting currents, and circular stapler during surgery. He also cites rectovaginal exams as the most critical tool for assessing endometriosis. One of the most significant factors in treating endometriosis is proper training of the surgeon thus that they can efficiently excise the affected area(s). Over the course of the presentation, Dr. Reich shares many videos and images of endometriosis surgeries to illustrate concepts and methods pertinent to the surgical treatment of endometriosis.

Dr. Reich also brings to the audience’s attention that high-quality endometriosis surgery is sparse in the United States. Dr. Reich argues that one of the culprits for this lesser quality of care is the American Congress of Obstetricians and Gynecologists. Dr. Reich states that this organization prioritizes many other entities, ultimately paying little to no regard to the welfare of women suffering from endometriosis. He also cites Big Pharma as another culprit.

Dr. Reich’s entire presentation can be found at the following URL: https://www.endofound.org/video/endometriosis-hormonal-or-surgical-my-reality-harry-reich-md-facog-facs/1548.