Endometriosis Essentials: A talk by Dr. Seckin

In an enlightening talk during the 15^th Annual Patient Symposium 2024, Dr. Seckin discussed the essentials of endometriosis, its progression, and excision surgery as a viable treatment option. He also stressed the importance of creating awareness about early diagnosis and intervention and the need for a healthy patient-surgeon dialogue.

Endometriosis is treatable, Dr. Seckin said

Dr. Seckin started the talk by reassuring women that endometriosis is treatable with the right doctor and caregivers. He describes endometriosis as a multiple-organ disease and the most complicated non-malignant disease.

He then drew parallels between observing the night sky and observing the pelvis.

“Just like how we do not get to see darker elements in the sky, there is more to endometriosis beyond just visible lesions,” he said. “We also get to see only the bright side of the moon but not the other side that is dark. As you look at the sky, there’s negative energy there. Truthfully, endometriosis is negative energy inside”.

Dr. Seckin also highlighted the need to fight taboos and myths surrounding menstruation and endometriosis. He showed how there are various taboos associated with menstruation despite our significant progress in scientific understanding.

“Men have died at war. But women have died just because they are women,” he said.

Early diagnosis is paramount according to Dr. Seckin

Highlighting the importance of early diagnosis and proper management, Dr. Seckin advocates for excision surgery as a treatment for endometriosis. He criticized the use of hormonal drugs and inadequate medical management. Instead, he promoted a patient-centered approach that includes postoperative care and empathy. He noted that academic circles have finally started realizing that surgery is a viable option.

“Patient-centered medicine is the priority, the choice of surgery or medical management remains the prerogative of each individual woman,” he said.

Dr. Seckin then explained the progression of endometriosis, from peritoneal lesions to more severe forms affecting the bowel and thoracic regions. He highlighted the contributions of Sampson for his theory of retrograde menstruation. To date, this remains the most convincing explanation for endometriosis formation.  

Based on this, all forms of endometriosis that we know today including deep infiltrating endometriosis and ovarian endometriomas show molecular evidence that point their origins to intrauterine endometrial tissue. These endometriosis lesions are also progesterone-resistant and secrete their own estrogen.

Peritoneal endometriosis: the biggest “troublemaker”

Dr. Seckin also described peritoneal endometriosis as the biggest troublemaker as there is no blood test or imaging technique to detect it. Patients with peritoneal endometriosis suffer in silence with the families not knowing about it till it leads to an emergency. Peritoneal endometriosis is also the main reason why it can take up to 10 years or more for a confirmed diagnosis.

He then showed observations from his own surgical experience using images stained with Aqua Blue Contrast (ABC) for better visibility and differentiation. He also emphasized that everyone’s endometriosis is different due to their genetic makeup.

“Some have more and some have less vasculature”, he said.

Finally, He stressed the need for meticulous surgery to remove lesions and prevent further complications.

Endometriosis is a progressive disease

Talking about whether endometriosis is a progressive disease, Dr. Seckin said that symptoms are progressive 80% of the time. The first signs are seen between ages 14 and 20 and things start becoming worse with age. He also noted an observation from the 12,000 excisions he has performed on close to 870 patients to date that endometriosis occurs predominantly more on the left side of the pelvis than on the right.

Conclusion

In conclusion, Dr. Seckin once again stressed the importance of proper disease understanding and awareness for patients and medical professionals. He emphasized the need for meticulous surgery and showed examples of his own work.

“We are obligated to identify every small lesion possible… The patient has to know that their fibrosis is removed,” he said