Dr. Harry Reich's article

[Guest guest]

Carla asked for feedback on Dr. Reich's article. I didn't have the time to read

the whole article, so maybe I missed the answers to some of my points. But here

are my thoughts on the parts that I did read.

It started off very promising; he stated that most fibroids are asymptomatic and

surgery can usually be avoided.

>> Myomectomy by any route is a controversial subject. Since when???

>>Most leiomyomatas do not interfere with fertility or childbearing (Féderation

CECOS, Schwartz D, Mayaux MJ), and results of myomectomy to improve fertility

are marginal (Berkeley AS, DeCherney AH, Polan ML) ( JA, Wrixon W, Janes

LB, EH).

Is there really major research to support this? Am I correct in believing that

most research does NOT support this? Particularly the second part?

>>Extensive myomectomies by laparotomy or laparoscopy are not justified in

patients who no longer wish to reproduce because the morbidity and mortality of

myomectomy is comparable with that of hysterectomy in these situations.

Huh? Once again, the old argument. If you don't want to reproduce, there is NO

point in having a myomectomy instead of hysterectomy. How very 19th century.

>>For those women who wish to have a myomectomy, and request it of their

physician, he or she is obliged to review the risks and benefits of all options.

If an abdominal incision is the major concern, these women often accept

laparoscopic hysterectomy with morcellation and ovarian preservation as an

alternative if counseled properly.

I know some women here have posted that avoiding a scar is a big issue for them,

but I'd say that they are in the minority. Sorry, but I read this to mean, 'if

you do a good sell job, you can browbeat them into a laparoscopic hysterectomy,

and even let them keep their ovaries'.

>>In some women, any type of hysterectomy is unacceptable, and the surgeon’s

decision to undertake these challenging myomectomy cases, despite attendant

risks, is proportional to his or her developed surgical skills; only then is the

issue of laparoscopic versus laparotomy myomectomy appropriate, depending on the

particular expertise of the surgeon.

Well, I'll agree here that the surgeon should consider his/her surgical skills

when making this decision. (I'd go a step further and say he/she should inform

the patient, " I don't have the skills to do this, but my colleague, Dr. X.

does " .)

>>The issue of insurance coverage may be critical in these decisions, as many

insurance companies reimburse less for the more difficult to perform

laparoscopic operation. If an abdominal myomectomy or hysterectomy is indicated

and the patient chooses laparoscopic myomectomy, the insurance company may

consider the surgery to be " cosmetic " (avoiding an abdominal scar), and the

patient may have to cover a large portion of the cost. Medical insurance

companies who do not discriminate against women should provide reasonable

reimbursement to their participating physicians who perform this " patient

choice " surgical procedure.

Does this really happen? Has anybody here had their claim denied, or a major

portion of it, because their surgery was considered cosmetic? Is this something

that the insurance companies are doing, without telling us why they are not

paying the full claims? And is it true that laparoscopic surgery is reimbursed

at a lower rate that abdominal/laparotomy operations? Maybe it depends on how

the doctor presents it to the insurance company? Maybe if my doctor had said

" well, I wanted to do a hysterectomy, but SHE insisted on a myomectomy " they

would have reimbursed differently? (I doubt it, but....)

Lots of medical stuff that I skimmed; all the details as to how he performs this

surgery.....

>>Laparoscopic myomectomy was done in 109 patients in the past 5 years, and 65

patients were able to be contacted and interviewed .....Of these women, 62 were

satisfied with their choice and result ( 95% satisfaction rate). Although 13

patients (20%) went on to have a hysterectomy, 11 of these were satisfied with

their initial choice of uterine preservation.

20% of his myomectomy patients went on to have a hysterectomy? I don't think we

have anywhere near that rate. The only reason I would think of would be that he

couldn't remove all the fibroids, so further treatment was indicated. Not a

very good success rate, to me. I guess 20% needing further treatment isn't so

bad; but why did they have to have hysterectomies?

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He suggests performing the procedure right before ovulation, but doesn't ever

mention why (or did I miss this?) And he suggests being careful not to damage

a corpus luteum. Had to go look that up and see if it's what I recall. Yes, it

is. Definition: yellow endocrine tissue that forms in a ruptured Graafian

follicle following the release of an ovum. Is this basically to be sure that

the woman might not be a few days pregnant? I know that for abdominal

myomectomies, most of us have been told that it does not matter at all where we

are in our cycle. (Especially since so many women have been bleeding nonstop

for months, and couldn't tell when they last ovulated anyway.) For those who

have had lap myos been told to schedule it right before ovulation? And why? Is

this a right-to-life issue?

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In summation, it seems like a good article on how to perform a laparoscopic

myomectomy, although I don't have the knowledge to really be sure. What it is

NOT, is a good article on why one should push a lap myo, or a lap hyst. over an

abdominal myomectomy. But since he clearly believes that the uterus is only

useful for childbearing, I can understand why he sees no point in leaving it in

if that is no longer desired. He clearly shows no understanding of reasons

women might not want some of this surgery. He seems to see the abdominal scar

as the most common objection.

I realize that any surgery, even a simple one, sounds complicated to the

layperson. But he makes this one sound incredibly complex; way more complex

than an abdominal myomectomy. Is that really the case?

Out of curiosity, I went to http://www.medicalconsumers.org/index.html the

website that, unfortunately only exists for New York State, reporting the number

of times a physician has performed a given procedure. For the calendar year

2001 (latest available), here are the statistics listed for Dr. Reich, for the

procedures I found.

Laparoscopically assisted vaginal hysterectomy: 3

Uterine myomectomy

9

Total abdominal hysterectomy

5

It doesn't seem to show numbers of laparoscopic myomectomies; I wrote them and

asked that they start listing that procedure. It seems like he does not perform

very much surgery. Or maybe he mainly performs laparoscopic myos and they don't

get listed. Anybody know more about him?

R.