Tackling Fibroid, Endometriosis through Laparoscopy

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Abayomi-Ajayi

While many Nigerian women continue to nurse the pain of infertility due to fibroids, endometriosis or ovarian cysts, experts believe they have a high chance of overcoming the challenge with the use of laparoscopy, a technology which involves minimally invasive procedures. Martins Ifjeh writes

When Adaugochi E, a banker, got married in 2015, she did not envisage she and her husband were going to experience fertility challenges. It was the least on her mind. Prior to her wedding, she had undergone abortion once for him since they were not ready at the time to take the relationship to the next level. So, in her mind, she had no fertility issues.

Few years into marriage, it dawned on Adaugochi that something was wrong. And then the young couple started to move from pillar to post. Diagnosis proved all was well except for the huge bouts of fibroid she was battling with. By December 2018, Adaugochi had done three surgeries to remove the growth from her uterus; the more she tried, the more the mass returned, thereby preventing her from getting pregnant and having a child of her own. It was the scariest thing she has seen.

Raising her cloth to show her belly, it appeared Adaugochi had done several caesarian sessions. But no. They were the surgeries done to remove the episodes of fibroid she kept experiencing. And none of these surgeries has successfully resulted in pregnancy.
10 months after the last operation, her belly has started to protrude again as though she was expecting a baby. But she knows, yet again, another mass of fibroid was finding footings where her unborn babies should bud.

Linda has been living with fibroid since she was 18. At 25, the protrusion in her abdomen could pass for a woman with seven months pregnancy. In 2017, she had an MRI, and was told she had at least 17 fibroids. Linda desperately wants to have children, but with her fibroid ranging from four centimetres to 12 centimetres, doctors say she would first require treatment.

“We first tried a uterine fibroid embolization, but that only shrunk them 50 per cent. A year later, I had a myomectomy removing nine of 17 fibroids. I was going through all of this, to proceed with Invitro Fertilisation (IVF), but after one failed cycle we are back at square one because the fibroids have grown back again and the doctor says I need to have another myomectomy,” she said.

Adaugochi and Linda are just two among the millions of Nigerian women currently experiencing issues associated with fibroid. While some, despite the challenge have been able to have children, others find it difficult to break the chain.

Experts described fibroid as benign tumor that grows in or on the uterus, or womb which may either impact infertility or pregnancy chances. They said about 20 to 80 per cent of women develop these noncancerous growth by age 50, and 30 per cent of women between ages 25 and 44 have symptoms of fibroids; thereby making uterine fibroids common during a woman’s childbearing years.
Managing Fibroids using Laparoscopy

But despite the huge challenge caused by fibroid and its associated fertility issues, the Managing Director, Nordica Fertility Centre, Dr. Abayomi Ajayi believes it can be effectively managed using endoscopy (laparoscopy); a technology described as a minimally invasive procedure which allows a key hole incision for a laparoscope to successfully address issues in the organ or tissue of focus. He also said the technology has a role to play in addressing endometriosis, ovarian cyst and other forms of infertility.

According to him, fibroids were better tackled laparoscopically than with open surgery if they are not too large, adding that the procedure was much cheaper and safer than open surgeries because it is associated with shorter hospital stay, as well as occurs with minimal blood loss.
He said when a woman has a protruding abdomen but not pregnant, she could be suspected to have uterine fibroids. “These fibroids are found in one out of five women of reproductive age, but are more common among black women. The exact cause is unclear, but it may be a combination of genetic, hormonal, and environmental factors. It is true that not all women with fibroids have symptoms but there are chances that if one has symptoms, she will often find the fibroids hard to live with.

“A laparoscopy is used to diagnose and treat women with fertility problems. What this amount to is that a laparoscopy of the reproductive organs (a gynaecological laparoscopy) is quite often necessary. In the past, this technique was not so readily available, but these days, the feasibility of laparoscopic surgery particularly in Nigeria is more common. This is fast gaining ground in Nigeria just like the rest of the world. It is cheaper, less complex and presumed safer than open access surgery and, hence, brightens the future of gynaecologic surgery.

“Laparoscopy is now utilised to carry out virtually every medical procedure that can be done through open surgery in gynaecology, ranging from surgeries involving the uterus, fibroids, early stages of ovarian cancer, and difficulty in getting pregnant from blocked fallopian tubes.”
He said infertile couples trying to resolve their issues often stand to benefit from the procedure, adding that, for instance, in selected couples with infertility from blocked fallopian tubes, surgery can be done laparoscopically in other for them to attain pregnancy.

The fertility expert, whose organisation is one of the few centres across Nigeria currently performing endoscopy, said if wombs have to be removed for any reason, they can be done laparoscopically.
e said: “Clinically, this procedure is almost infinitely useful in gynaecology practice particularly because the trauma of opening somebody up with a wide incision and the challenge of recovery afterwards is completely removed.

“The opening is minimal just like a “keyhole” and it allows the body to recover much faster unlike opening up the womb through the normal traditional method, in which you would have been on admission for a number of days, but in laparoscopy, you can return home within 24 hours.”
Ajayi, who said the most common cause of female infertility in Nigeria is tubal blockage as a result of infections, also noted that the advantage of laparoscopy was that when used for diagnosis, it can also be used to treat, adding that the limitations were often the expertise and experience of the surgeons.

According to him, during a gynaecological laparoscopy, a small incision will be made in the abdomen (small is good for risk reduction and recovery), and then a tube with light and camera attached (laparoscope) is guided into the pelvic area.

“Secondary incisions may also be made nearby, allowing small surgical tools and gas to be pumped in, creating a better view of the reproductive organs. The aim is to seek out cysts, fibroids, endometriosis, ectopic pregnancies, pelvic inflammatory disease, adhesions, infections and other issues that may be affecting fertility. It lasts up to 60-90 minutes, depending on what’s done. Depending on the procedure patient may go home after a few hours in the recovery room.”
How Laparoscopy can Address Endometriosis

He said many couples with unexplained infertility can benefit from laparoscopy to check for abnormalities in the woman, with conditions such as endometriosis picked up through the technology.

While noting that endometriosis cannot be cured, he said it can be managed through non-invasive procedures before surgery. “If you are trying to get pregnant, the treatment option is usually either surgery or IVF as medication used for endometriosis usually stops ovulation and therefore prevents pregnancy. So, laparoscopy is usually the surgery of choice to treat endometriosis. It involves removing the endometrial growths while protecting the ovaries and uterus.”

He said if unfortunately, endometriosis surgery didn’t result in pregnancy, the female can as well freeze her eggs or try other options of Assisted Reproduction Techniques (ART).

“The bottom line is that getting pregnant after laparoscopy is improved. In early-stage endometriosis, it is useful to help diagnose and treat women with infertility problems. A laparoscopy can therefore be operative, not just diagnostic.

“Meaning that if something is found wrong, it can be dealt with there and then. Some tubal repairs may be unnecessary in the face of IVF technology. But if you have had one or two failed IVF cycles, you will want to do everything you can to get to the root of the problem,” the fertility expert added.

Tosin, 38, Urgently Needs N1.2M to Treat Deadly Tumor
Martins Ifijeh

38 years old Mrs. Tosin Obaro from Ogun State is urgently in need of at least N1.2 million for surgical procedure to treat deadly nasopharyngeal carcinoma.
Doctors believe the carcinoma, which started two years ago, can be surgically treated so she can lead a normal life.
Consultant Radiologist, Mecure Healthcare, Dr, Ukwaigwe C, described the deadly tumor as antrochonal polyps with chronic pan sinusitis and bilateral OMC blockage.

According to her husband, Joseph Obaro, the carcinoma has deprived her of many things, including her sight, voice, facial figures, her job as a business woman, as well as her role as a mother.
“I have spent all I have just to keep her going. I have sold my properties and borrowed money from everyone I know. I do not want her to die. I am calling on well-meaning Nigerians, nongovernmental organisations, Ogun State government and religious organisations to come to our aid,” he said tearfully.
For support, Mrs Obaro can be reac
hed on 07052121989 and 08151206664. Account number: 0018922487, bank name: Guaranty Trust Bank, account name: Kehinde Joseph Obaro.