Georges Akl, MD, FACOG

Alternative treatments available for chronic gynecological symptoms

Published May 15, 2017 at 4:00pm

For many women, living with chronic gynecological symptoms like pelvic pain or excessive bleeding is more than an inconvenience.The symptoms can limit everyday activities and contribute to fatigue, especially if abnormal menstrual bleeding results in anemia. Unfortunately, some studies have found that women live with these symptoms for years before talking to their doctor.

Obstetrician/gynecologist Georges Akl, MD, FACOG, recommends that women be proactive in discussing their symptoms with their doctor because there are many treatment options available including medication or a surgical intervention if other options have been exhausted.

“I want my patients to understand that I will discuss with them all options available to them to treat their symptoms,” said Dr. Akl, who practices at Mohawk Valley Women’s Health Associates with Lauren Giustra, M.D., and Ankur Desai, M.D. The specialists deliver babies and perform their surgical gynecological procedures at Rome Memorial Hospital, which is recognized for quality and patient satisfaction.

Board certified by the American Board of Obstetrics and Gynecology, Dr. Akl, earned his doctor of medicine degree from The Lebanese University, Lebanon and completed his OB/GYN residency training at SUNY Upstate Medical University, Syracuse. He is a member of the American College of Obstetrics and Gynecologists and a member of the American Medical Association.  

“Except for patients with uterine cancer, there are alternatives treatments for most problems that we can try before considering a hysterectomy. I will give my patients all the information they need to make an informed decision,” Dr. Akl said.

Although the number of hysterectomies performed in the United States has declined with more treatment options available, it is still the second most common surgical procedure among women in the Unites States.Approximately half of hysterectomies are performed to treat benign uterine growths, such as fibroids, which can cause abnormal bleeding.

A hysterectomy may also be performed for uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal; cancer of the uterus, cervix, or ovaries; endometriosis, a disorder in which tissue that normally lines the uterus grows outside the uterus; abnormal vaginal bleeding; or chronic pelvic pain

“A hysterectomy is a major surgery and should only be performed as a last resort solution to resolve gynecological problems that a woman may be experiencing, when all other conventional treatments have not provided relief of her symptoms,” said Dr. Akl, who has extensive knowledge, training, and expertise in advanced laparoscopic hysterectomy surgery, a technique which is much less invasive than the standard open abdominal surgery and offers a shorter recovery and less scaring.  

“Over 90 percent of hysterectomies are done using minimally invasive surgical techniques being vaginal or laparoscopic,” Dr. Akl said. “Laparoscopic hysterectomies involve only three or four small incisions, require less time in the operating room, less time under anesthesia, less pain, a shorter hospital stay and a quicker return for the patient to their regular activities. Plus there is minimal scaring.”

In a laparoscopic hysterectomy a small incision is made in the belly button and a tiny camera is inserted. The surgeon watches the image from this camera on a monitor and performs the operative procedure. Two or three other tiny incisions are made in the lower abdomen where specialized instruments are inserted and used for the removal process.

Although the field of robotic surgery has developed rapidly, it hasn’t been shown to improve patient outcomes and is more costly than minimally invasive laparoscopic surgery, according to the Committee on Gynecologic Practice Society of Gynecologic Surgeons.  

“Some surgeons have said that they like the 3D views provided by the robotic equipment, but for me, I do not feel that the robotic control levers give the surgeon the touch feedback of actually handling the surgical instruments,” Dr. Akl said.  

Younger women who may need to have a hysterectomy may have concerns that the surgery will trigger early onset menopause. Dr. Akl explained that depends upon whether or not there is reason to also remove the patient’s ovaries.

“When we say that a woman has a total hysterectomy, that means that we remove the uterus and the cervix,” Dr. Akl said. “Taking out the ovaries is dependent on the patient. If the patient is post menopausal, then her ovaries are no longer functional and can be taken out. This is called an oophorectomy. If a patient is pre-menopausal, taking both the ovaries will trigger menopause and the complications associated with this change in hormone production. Because of this, when possible, one or both of the ovaries are left after a hysterectomy. Unless the ovaries are removed, undergoing a hysterectomy alone does not trigger menopause regardless of the age of the patient.”

“Recently it has been determined that some ovarian cancer may begin in the fallopian tubes, so in many instances we are now taking the tubes out as well during a routine hysterectomy,” he continued. “Removing the fallopian tubes is called a salpingectomy. There is no benefit to leaving the tubes so surgeons tend to take them out now unless doing so would be too challenging.”  

Mohawk Valley Women’s Health Associates has been providing obstetrical/gynecological care for women from adolescence through their seniors years for more than 20 years. The practice is accepting new patients and has offices at 107 E. Chestnut St., Rome, and at 1 Paris Road, New Hartford. To make an appointment in Rome, call (315) 334-9663 or in New Hartford (315) 797-8661.