Mr Ashwini K Trehan MBBS, DRCOG, FRCOG, FRCS (Edin)

Consultant Minimal Access Gynaecologist
 

(Gynaecologist - specialising in keyhole hysterectomies and treatment of endometriosis)

Recognised "Endometriosis Centre" for the management of advanced Endometriosis

by

 BSGE (British Society of Gynaecological Endoscopy)

Have you been advised to have your Ovaries removed to treat Endometriois? Consider these points first

Do you suffer with pelvic pain or have Endometriosis? Consider these points first

Mr Trehan is a (Keyhole) Laparoscopic Minimal Access Gynaecological Surgeon. He is well known for his excision treatment of endometriosis and keyhole hysterectomies.

Mr Trehan has shown a unique new direction to the future of major/complex gynaecological surgery by proving that almost all non-cancerous gynaecological surgery can be undertaken via keyhole means. He strongly believes that there is very little need for the traditional and widely used choice of open surgery where a large cut is given to the patient’s stomach.

Mr Trehan has pioneered, developed, introduced and is running effectively the UK’s only one of its kind “Overnight hospital stay service following major benign gynaecological surgery". He also offers one of the most advanced endometriosis surgical services.

Mr Trehan’s expertise has also demonstrated that after major/complex gynaecological surgery almost all patients can return home after overnight hospital stay and return to daily activities within days. This contrasts to the usual duration of 5-7 days in the hospital post surgery and weeks of recovery. 

Mr Trehan’s keyhole experience as a consultant spans over a period of 16 years and he has completed over 2000 major benign gynaecological procedures using keyhole surgery. The majority of his operations involve complicated procedures, many of which are referred to him by other consultants and from other parts of the country (many of whom have had several previous operations by others by the time to come to see Mr Trehan).

Patient safety is Mr Trehan’s prime consideration, which is substantiated by miniscule complication rates of his surgery in spite of operating on patients with complicated problems.

Scroll down for information on endometriosis treatment , keyhole hysterectomy, and keyhole surgery for other gynaecological conditions

Women having their operation by him are confident that:

• Their operation will be completed by laparoscope as his conversion (change over to open operation during keyhole) rate is under 0.3%.

• Their overall risks of suffering a complication is miniscule, and is among one of the lowest reported in the literature.

• It is unlikely they will be readmitted due to complications, as there has been only one acute readmission for wound problem among over 1200 consecutive patients (the national readmission rate is 5-7%).

• That they will be fit to leave for home after overnight stay. Over 90% of Mr Trehan's patients do leave after an overnight stay (most of those staying back for more than one night did so for social reasons).

The success of his service can be demonstrated by the fact that they attract tertiary referrals & patients nationally. In addition, they have been covered widely by newspapers both national (1998, 1999, 2007) and locally on numerous occasions, as well as on Television (ITV 1999, BBC1 2003). Furthermore, his services have been complimented in the House of Lords (2004) by the Under Secretary of State, Lord Warner and have attracted the Modernisation Agency of the Department Of Health. Likewise, his service has received several awards (1998,2003, 2004, 2006,2007).
 
Mr Trehan undertakes a wide range of benign intra abdominal gynaecological operations by keyhole means. The includes hysterectomies, myomectomies, ovarian cysts including those occurring in pregnancy (cysts of any size and type and also all cyst complications), tubal surgery, extensive adhesiolysis, excision procedures for endometriosis including rectovaginal advanced disease, tubo-ovarian abscess and masses, drilling the ovaries for polycystic disease, surgical treatment of ectopic pregnancy, Ventrosuspension (bringing the tilted womb forward ) and other benign gynaecological procedures for which patients traditionally required laparotomy (an open cut on the stomach), prolonged hospital stays and long recovery times.

ENDOMETRIOSIS EXCISION - THE MODERN MANAGEMENT

• Endometriosis is a common gynaecological condition resulting in pelvic pain and infertility.

• Although medicine is extensively used for this condition, the most effective treatment is surgical.

• Surgery for endometriosis is best undertaken using a keyhole approach. Keyhole surgery enables the surgeon to access all areas of the pelvis and magnify even very small areas of endometriosis (which open surgery is unable to do).

• With the help of the keyhole approach, excisional treatment for the endometriosis is undertaken. In this, the endometriosis is excised off (peeled off), avoiding the need for a hysterectomy and/or the removal of the ovaries. Excisional treatment is the most effective, successful and modern treatment has several advantages over the “burning method?with laser or cautery.

• Mr Trehan offers excisional treatment for all grades (stages 1 - 4)  of endometriosis (which may include the bowel and severe adhesions) by keyhole means. Excisional treatment is one of the most demanding gynaecological operations requiring special training.

• The operation can take anything between 2 to 8 hours depending upon the stage of the disease.

• Over 90% of the patients following endometriosis surgical treatment by Mr Trehan are fit to leave hospital after only one night’s stay.

• Excision treatment cures/improves pain and at the same time avoids the need for hysterectomy and/or removal of ovaries and also improves the chances of pregnancy in those who are trying for a baby.

• On occasions, if a hysterectomy is necessary (when the uterus itself is diseased), Mr. Trehan always combines a hysterectomy with excisional treatment as it is well documented that the pain may persist if the endometriosis is not removed via excision at the time of hysterectomy. Therefore, a hysterectomy for endometriosis should never be done without also removing the endometriosis (excision).

• Despite it being common practice, Mr Trehan believes and practices that both ovaries should not be removed (bilateral oophorectomy) in any woman with endometriosis under the age of 50 - the ovaries can almost always be saved with proper excision operation.
  

Surgical Treatment Video, click here >

Radical Excision of Endometriosis

Mr Trehan has implemented an improvement of the technique for excisional treatment of endometriosis, in order to improve the outcome results of the procedure as well as preventing the removal of the ovaries.  For more information on this, click here to view the presentation (with minor changes) which Mr Trehan presented at the International Conferences (Lisbon 2001, San Diego 2002, Glasgow 2003, San Francisco 2004, London 2005, Kuala Lumpur 2006).  This presentation also shows Mr Trehan's outcome results of Radical  Excision of Endometriosis.

50% cases of endometriosis have bowel involvement. It is a severe form of endometriosis. It can only be treated appropriately by an endometriosis specialist and requires an advanced form of surgery. Although many treat this form of endometriosis by bowel resection (removing part of bowel), Mr Trehan always undertakes shaving of the bowel (stripping the endometriosis of the bowel) for treatment of this condition. The reason he undertakes shaving as opposed to resection is that in a resection, the removal of a portion of the bowel is associated with a 10?5 % risk of severe complications such as faecal leakage, peritonitis, rectovaginal fistula, colostomy, anterior resection syndrome and effects on future fertility. Moreover, the improvement in quality of life and pain symptoms are similar following both forms of treatment.

Mr Trehan appeared on the BBC's Politics Show on 23rd November 2003 to give his opinion on modern surgical treatment of endometriosis.

For further information on endometriosis and the treatment of endometriosis, please visit the "Endometriosis Facts" page, click here.

KEYHOLE (LAPAROSCOPIC) HYSTERECTOMY - THE FUTURE
Hysterectomies are becoming a less common operation due to the use of Mirena® (hormones) coil and ablative technique where lining of the womb is destroyed by heat treatment.  If hysterectomy is needed, it is usually for endometriosis, pelvic inflammatory disease (infection) and adhesions, fibroids, or associated benign cysts.  These can be dealt with more effectively by the use of keyhole surgery at the time of the hysterectomy - via a keyhole hysterectomy, rather than open conventional operation (total abdominal hysterectomy) or vaginal hysterectomy.

Mr Trehan undertakes all hysterectomies for non-cancerous conditions by keyhole means (except for womb larger than 18 weeks pregnant uterus). Over 90% of the patients following a hysterectomy are fit to leave hospital after one nights stay. He has pioneered overnight stay hysterectomy service in the UK with the biggest number of recorded and published series.  For details refer to his article “Hysterectomy ?towards an overnight stay?(Click here)

An article by Sheron Boyle in the Daily Mail regarding Mr Trehan's work highlighted the advantages of keyhole hysterectomy.  Click here to view the article.

To view pictures of keyhole hysterectomy for large fibroids being undertaken, click here.

OTHER BENIGN GYNAECOLOGICAL CONDITIONS

Mr. Trehan offers keyhole surgery for all these conditions and gets consistently excellent results. Over 90% of patients following surgery are fit to leave hospital after one nights stay. Click here to view his audit outcome.

• NON CANCEROUS (BENIGN) OVARIAN CYSTS
  Mr. Trehan always undertakes keyhole surgery for all types of non-cancerous cysts of the ovary (over the past 15 years, Mr Trehan has undertaken each and every cyst removal via keyhole means), including those occurring in pregnancy (cysts of any size and type and also all cyst complications),  To view further information & pictures of a keyhole operation on dermoid cysts of the ovary, click here.  To view further information & pictures of a keyhole operation on ovarian cysts during pregnancy, click here.  In order to view an example of the removal of a particularly large cyst during pregnancy, click here.

• POLYCYSTIC OVARIES (OVARIAN DRILLING)
  Laparoscopic (keyhole) ovarian drilling is the most modern surgical operation for polycystic ovaries. To view further information & pictures of a keyhole operation on polycystic ovaries, click here.

• LAPAROSCOPIC (KEYHOLE) REMOVAL OF FIBROID (MYOMECTOMY)
  Mr. Trehan undertakes myomectomy operations by keyhole means (providing the fibroids are not too large or numerous).  To view further information & pictures of a keyhole myomectomy operation, click here.

• LAPAROSCOPIC (KEYHOLE) MANAGEMENT OF PREGNANCIES OUTSIDE THE UTERUS (ECTOPIC PREGNANCY)
  Mr. Trehan always undertakes operations for the management of ectopic preganancies by keyhole means.  To view further information & pictures of keyhole operations for ectopic pregnancies, click here.

• LAPAROSCOPIC (KEYHOLE) TUBAL SURGERY TO OPEN BLOCKED FALLOPIAN TUBES (SALPINGOSTOMY)
  Mr. Trehan undertakes salpingostomy operations for infertile women by keyhole means.  To view further information & pictures a of keyhole salpingostomy operation, click here.

• LAPAROSCOPIC VENTROSUSPENSION (FOR TILTED (RETROVERTED) WOMB)
  Mr. Trehan always undertakes ventrosuspension operations by keyhole means.  To view further information & pictures of a keyhole venrosuspension operation, click here.

• LAPAROSCOPIC EXCISION OF THE VAGINAL APEX (POST HYSTERCTOMY VAGINAL VAULT SCAR)
  Mr. Trehan undertakes this operation operations by keyhole means for women suffering with chronic pelvic pain and dyspareunia (painful intercourse) following a hysterctomy.  To view further information of this procedure, click here to view the abstract presented by Mr Trehan at the World Congress of Endometriosis in 2008 in Melbourne, Australia.

TEACHING & TRAINING
Mr Trehan is a Royal college - recognised principle for laparoscopic training.

DOCUMENTATION & PHOTOGRAPHS
Mr Trehan routinely takes photographs of the pathology (disease) at the time of keyhole surgery to document the findings before, during and after the operation.  This helps patients understand their condition better and is useful for future records if further investigation / treatment is necessary and is also useful for medicolegal purposes.

INTERNATIONAL PRESENTATIONS & PUBLICATIONS
Mr Trehan has written peer reviewed papers and presented abstracts relating to his work all over the world and is propagating his view points on a wider scale. To view the publications and a list of presentations which Mr Trehan has presented, click here.

Not only has Mr Trehan pioneered and run effectively a unique service, but based on his service he has also floated his vision to the to the department of health to establish “Multidisciplinary Overnight Hospital Stay Unit in every NHS hospital to overcome the bed crisis, save NHS resources and reduce hospital acquired infection. To view information on the unique service which he has implemented and his future vision for the NHS, click here.