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

Consultant Minimal Access Gynaecologist

(with special interest in Endometriosis and Keyhole Surgery)

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 who undertakes almost all major benign gynaecological operations by keyhole means, for which a laparotomy (an open cut on the stomach) is normally needed. Mr Trehan has shown a unique new direction to the future of major gynaecological surgery by proving that almost all major benign intra-abdominal gynaecological cases apart from a few exceptions can be managed laparoscopally (keyhole) with an overnight hospital stay and rapid return to normal activities with enormous advantages in terms of resource saving and patient recovery. In his unit, he believes the laparotomy (an open cut on the stomach) to be the rare exception rather than the rule, and he analyses and questions his practice should a patient stay more than one night postoperatively following major gynaecological surgery, including complex endometriosis surgery lasting anything up to 8 hours.

Click here to view the advantages of keyhole surgery.

His special interests include endometriosis and minimal access (keyhole) surgery. He is well known for excision treatment of endometriosis and keyhole hysterectomy. 

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,” where patients are fit to leave hospital after only one night's stay rather than the conventional practice of 5-7 nights. This is also true for complex endometriosis surgery lasting anything between 4 to 8 hours.  Mr Trehan has also introduced one of the most advanced endometriosis surgical services in the region. 

Mr Trehan’s keyhole experience as a consultant spans over a period of 15 years.  The majority of his operations involve complicated procedures, many of which are referred to him by other consultants and other parts of the country (tertiary referrals) due to their complex nature.  The patients’ safety is his prime consideration, which is substantiated by miniscule, very low complication rates of his surgery in spite his practice of treating and operating on patients with complicated pathologies.  He has vast experience having laparoscopically (ie. by keyhole means) completed over 1800 major benign gynaecological procedures. Over 90% of these patients were discharged home after an overnight post-operative stay; most of those staying back for more than one night did so for social reasons.

Regular audit of his work and peer reviewed papers demonstrate that his complication rate for major procedures are among the lowest reported in the literature.   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 1000 consecutive patients (the national readmission rate is 5-7%). Click here to view his detailed audit.

• That they will be fit to leave for home after overnight stay, as over 90% of Mr Trehan's patients do leave after an overnight stay.

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 which include the Hospital Doctor Merit Award for Innovation Team of the Year (2006), West Yorkshire Modernisation Award (2004), NHS Champion Kings Fund Award of Merit (2003), Community Magical People Award (2003) and runner up for Hospital Doctor Award (1998).   Click here to view media coverage regarding Mr Trehan's work.

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
Although medicine is extensively used for this condition the definite treatment is mainly surgical. This is best undertaken under the magnification of laparoscope using keyhole technique by excisional (peeling off) method which avoids the need for hysterectomy and/or the removal of ovaries.
Excision (peeling off) the endometriosis seems to be the most effective, successful and modern treatment.  It has several advantages over the burning method with laser or cautery.  Refer to “Endometriosis - the facts” for more information by clicking here.

Mr Trehan offers excisional treatment for all grades of endometriosis (stages 1 - 4) by keyhole means. Excisional treatment is the most demanding gynaecological operations requiring special training. The operation can take anything between 2 to 8 hours depending upon stage of 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 when hysterectomy is necessary in the patients suffering with endometriosis, he always combines it with excision (peeling off) endometriosis.  It is well documented in the literature that pain may continue if endometriosis is not removed at the time of hysterectomy. He believes that the both ovaries should not be removed (bilateral oophorectomy) in woman under 50 years of age, not an uncommon practice and the ovaries can almost always be saved with proper excision operation. Refer to "endometriosis - the facts" for more information,  click here to view.  Click here to view his abstract presented at various international conferences. Click here to view his operations for endometriosis.

Video presentation on Modern Management of Endometriosis

Diagnosis & Medical Treatment Video, click here >

Surgical Treatment Video, click here >

Click here to view the presentation (It may take a few minutes to open the file, depending on your connection speed) which Mr Trehan presented at the International Conferences (San Francisco, 2004 & London 2005).  This presentation shows Mr Trehan's outcome results of Radical  Excision of Endometriosis, and the suggestion which Mr Trehan put forward in relation to improving the outcome of Excisional Treatment of Endometriosis.

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

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.