QC: Surgical vs. Non-Surgical Endo Management: Risks, Tools & Truths With Dr. Jeff Arrington

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Dr. Jeff Arrington joins us to discuss accessible endometriosis management options and surgical considerations for patients at different stages of their journey. We explore alternatives to excision surgery, the relationship between round ligament pain and endometriosis, and the real risks of deep excision procedures compared to standard gynecological surgeries.

• Various hormonal options including birth controls, progesterone-only medicines, and IUDs
• Low-risk alternatives like magnesium, omega-3s, turmeric, anti-inflammatory diets
• Physical therapy, acupuncture, and specialized pelvic pain clinics
• No clear connection between round ligament pain and endometriosis
• Deep excision risks include bleeding and organ injury but specialist complication rates are lower than for routine gynecological procedures
• Proper knowledge of pelvic nerves critical for preserving bladder and bowel function

Do you have more questions? Keep them coming! Send them in using the link in the top of the description of this podcast episode, by emailing [e-mail], or by visiting the endobattery.com contact page.

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights.
Short, powerful and right tothe point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.

(00:41):
Today I have an incredibleexpert joining us Dr Jeff
Arrington.
If you've spent any time in theendometriosis community, you've
probably heard his name.
Dr Arrington isn't just anexcision specialist.
He's a fierce advocate forinformed consent and breaking
down the barriers that keep somany from accessing proper
endometriosis care.
His passion goes beyond theoperating room.

(01:02):
He's fighting for real change,pushing back against
misinformation and making surethat patients have the knowledge
and options they deserve.
Let's dive in.
What's the best way to manageendometriosis symptoms if you
can't afford excision?

Speaker 2 (01:17):
Hard part, best way.
I don't know if there's a best,best way.
It's basically trying to findthings that help each individual
patient.
I mean there's a bazillionhormones that can be used.
Between all the different birthcontrols, progesterone-only
medicines, iuds.
There's the medicines that putyou into menopause a slew of
different hormones that patientscan try Patients head to head.

(01:39):
They're all proven about thesame.
Some patients may responddifferently to others.
I throw out a lot of otherthings that are very low risk.
Some patients find benefits,some don't.
So supplements like magnesium,omega-3s, turmeric,
anti-inflammatory type things,anti-inflammatory diet, physical
therapy, acupuncture,acupressure, and there's some

(01:59):
places that do dry needling.
There's a very number of thingsthat patients can try that some
get benefit from and some don't, but they're really low risk.
I'm fortunate enough here inUtah to have a couple of really
good chronic pelvic pain clinicsI went at the University of
Utah and one with IntermountainHealthcare for patients that
really need a complex approach,medical approach, to pelvic pain

(02:21):
.
Those are nice resources for meto have.

Speaker 1 (02:30):
Is there a connection between round ligament pain and
endometriosis?
And I think where this questioncame from is the correlation of
round ligament painspecifically during pregnancy
and then after pregnancy gotworse until excision.

Speaker 2 (02:43):
Not that I'm aware of .
I can't think of a reason whythey would be correlated, unless
if there's endometriosis in theinguinal canal that could mimic
around ligament pain.
If there's really deep, thickendometriosis that's binding or
shortening, pulling on the roundligaments, technically I guess
that could give some pain, butnot that I'm aware of.

Speaker 1 (03:01):
What are the biggest surgical risks associated with
deep excision?

Speaker 2 (03:06):
I mean typical ones, deep excision, certainly
bleeding.
You have to be aware of wherethe blood vessels are, how to
manage.
We try to take really good care.
Most of the endometriosisspecialists are very good
surgeons, very meticulousanatomists, and we're aware on
how to avoid blood vessels.
But sometimes that happens andyou need to know how to manage
stuff quickly.
Certainly injury to organs,either bowel, ureters or bladder

(03:30):
, but again, most of us are verycomfortable working around
those and if there is an injuryto the bowel or the bladder or
the ureter, really the key isjust getting it taken care of at
the time of surgery and as longas we do that at the original
surgery, the risk ofcomplication afterward is really
low.
It's the unrecognized ones thatare problematic.
Really, over the last 10 yearsor so we're learning a lot more

(03:50):
about the pelvic nerves and weused to go in and just cut away
at will.
But having a betterunderstanding of the hypogastric
nerves and the splenic nervesfor bladder and bowel function,
those are fairly high risk fordeep excision, just because some
of the common areas for deependometriosis are the pararectal
areas in the uterus, sacralligaments, and that's right
where all those nerves run, andso we have to really be aware of

(04:14):
those nerves, what theirfunctionality is, and do our
best to preserve as much as wecan.

Speaker 1 (04:18):
Also is there more risk with deep endometriosis,
with ureter involvement withoutproper care being severed.
The ureters being severed.

Speaker 2 (04:31):
Oh yeah, surgery done by an endometriosis specialist.
Probably I would have to lookit up but I would put money on
that.
We have a much lowercomplication rate than regular
gynecologists doing regularthings.
There are more.
It's more common to have aureter injury from just a
straightforward commonhysterectomy than it is for an
excision specialist doingcomplex deep endometriosis work.

Speaker 1 (04:55):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(05:20):
Until next time, keep feelingempowered through knowledge.