So, you may be reading this because you have a surgery pending, or you’ve had surgery and want to know if it was the “right” one.  Well, when it comes to Endometriosis, there are typically two ways of dealing with the lesions that I’ve read of. If there’s more, share with me, please!  Whichever way your surgeon opens you up : laparotomy or laparoscopy, robotic-assisted or not – your surgeon will still need to decide how best to handle the lesions he or she finds within your body.

1.  Excision – removing the entire lesion by cutting a margin of healthy flesh around the lesion – see the graphic above, scooping the healthy soil around the flower to get the roots, and then some.
2. Ablation – destroying the lesion by burning the surface away.  Like freezing off a mole or wart, but burning away the Endo.  The graphic above with the flamethrower may leave the roots of the lesion, and unhealthy Endometriosis tissue, behind…

Is one better than the other?  That’s purely a matter of opinion, but the popular opinion is, “yes!”  There are countless studies that agree.  But why?

Ablation only affects the surface of the lesion by destroying the tissue.  It may leave unseen portions of the disease beneath the surface, which may allow for speedy recurrence of Endometriosis growth and symptoms.  Ablation may also cause further scar tissue to develop – you are literally burning or melting the lesion away.  Other names for ablation may include cauterization, vaporization, and fulgeration.  Terms for some of the tools that may be used during ablation can be electrosurgical devices, thermocoagulation devices, lasers, a harmonic scalpel, helium or argon plasma therapy, and the cavitron ultrasonic surgical aspirator (CUSA).

Excision (sometimes called resection) removes the entire lesion, as well as a healthy bit of flesh around the lesion.  The surgeon hopes to remove all traces of that particular lesion, in the attempt to make recurrence more difficult.  The more lesions that can be excised, the better chances you may have at a longer symptom-free life.  Tools can be cold, hard cutting tools such as scissors or even lasers (but…but…heat energy – burning!?!) – nope, lasers are often used for excision surgeries to cut around the lesions and harvest it out whole.

You may be interested to go back, grab a copy of your operation report, and compare these tools and techniques.  What exactly DID your surgeon do?  Or you can use this information to better ask questions of your doctor prior to a pending surgery.

Imagine an avocado (mmmmm avocadoooo) – you slice that bad boy open, remove the pit, and discover a bit of browning on the surface.  Nasty bruises and icky…But, there’s plenty of good avocado still to be enjoyed.  If you only scraped off the surface of that brown spot, you’d likely still have MORE brown spot beneath it – that rotten little bruise extends deeper into the avocado flesh (delicious green flesh).  You’d want to take a spoon and scoop out the brown spot in it’s entirety, and enjoy the fresh avocado that you have remaining.

Also, think of an iceberg.  The tip is only visible above the surface of the water, but the iceberg can extend for quite a long while beneath the waves.  Endometriosis lesions do the same.  Who knows what’s lurking beneath the surface.  And if the entire iceberg – um, Endometriosis lesion – isn’t removed, it may resurface.

Studies have shown that women who undergo excision surgery of Endometriosis lesions have less painful periods, less painful bowel movements, and chronic pelvic pain than women who underwent ablation.  Studies also indicate that painful sex levels remain about the same for both excision and ablation surgeries.

Patients who undergo ablation surgery for Endometriosis have a 40-60% chance of recurrence, sometimes within months of surgery.  In contrast, 75-85% of those who undergo excision surgery claim long-term relief.    I personally have undergone six excision surgeries (June 2014, Sept. 2016, July 2018, Nov. 2018, May 2020, October 2020).  Some of my Endometriosis was in similar areas of my body as my first surgery, but some was found in new locations…My surgeon opted instead of excising (or even ablating) a lesion on my diaphragm, to leave it there for safety’s sake – nobody wants a perforated diaphragm (this lesion disappeared after my 2016 surgery)! Excision surgery may not be ideal in every situation – and a skilled surgeon will be able to know when, and when not, to cut.   Even then, it may not work and you still may be slated for a future surgery.  The only guarantee with this illness: there is no guarantee.

In the end, it’s not only about the type of surgery or the tools used – it boils down to the skill level of the surgeon and their method of dealing with Endometriosis.  How competent are they? Do they do excision or ablation?  How often do they perform excision surgeries?  What’s their recurrence rate among patients?  Ask questions! Get answers!  Be comfortable and confident with your surgeon’s skills.

And, as always – there is no cure for Endometriosis.  We may get relief from medication, supplements, lifestyle changes, or even surgeries, but there is always, always, the chance for recurrence.  Listen to your body.  And don’t be afraid to head back in for another consultation…

I’d like to extend a special Thank You to Sarah Soward, a local artist and EndoSister who granted me permission to use a detail of her Endo-Graphic as our cover photo for today.  To view the entire image and all of the information contained there, please visit her site.

(Updated February 3, 2021)

Resources:

Center for Endometriosis Care

Diamond Women’s Center

Endometriosis Australia

Endometriosis Foundation of America

Eric Daiter, M.D.

Nezhat.org

Sarah Soward

The Journal of Minimally Invasive Gynecology – (Unedited Manuscript; April 2017) Laparoscopic Excision Versus Ablation for Endometriosis-Associated Pain – Updated Systematic Review and Meta-Analysis

Vital Health Institute

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa