Endometriosis Surgery: Excision versus Ablation

Surgery is one of the most common forms of endometriosis treatment. It may not cure the disease, or get rid of all of the symptoms, but it can improve a patient's quality of life. It is currently considered the way forward by many healthcare providers. Many endometriosis patients have several procedures under their belts - I have two.

When treating endometriosis, surgeons will either favor excision, ablation, or both types. It is up to the surgeon carrying out the treatment to choose the type of surgery. When I was looking for a specialist to treat my endometriosis, many fellow patients told me that the most effective treatment would be excision surgery. However, when I finally spoke to my specialist, he told me he used both procedures depending on the type of adhesions and their location.

How does each procedure work?

Excision surgery

This method of surgery involves the resection or removal of endometriosis lesions, also known as adhesions. The aim is to cut out them completely, leaving nothing behind. It is more invasive than ablation, and requires a longer recovery time. Excision surgery is also more complex - so not every surgeon will have undergone the training required to perform it. It also tends to be more expensive. There is no guarantee that the disease will not come back, but reoccurrence rates are lower than with ablation surgery.

Ablation surgery

There are several types of ablation surgery including radiofrequency, freezing, electrosurgery, or the use of heat. Ablation will burn or vaporise adhesions, but not completely. It generally leaves scar tissue behind. The rates of recurrence are higher, although it is a cheaper procedure. Additionally, there are more surgeons trained in this technique.

Both generally involve laparoscopic surgery

First, the surgeon will make a single incision, generally near the bellybutton. Through this small incision, carbon dioxide gas is pumped into the abdomen. This allows the surgeon to see adhesions and other lesions easily. The laparoscope, a small flexible tube operating as light and camera, is inserted through this incision. Once the surgeon identifies the endometrial tissue and its location, they may perform further small cuts. Through these incisions, the surgeon can insert surgical instruments and remove as many adhesions as possible.

Recovery times will vary, depending on the amount of tissue removed and the procedure. The patient’s own healing mechanisms also play a huge role in this recovery. In my case, my second laparoscopy involved the removal of deep endometriosis through excision and ablation. It took me around 12 days until everything stopped feeling sore. I was able to go back to my fitness habits and active lifestyle after two months.

Ask your surgeon

One thing is clear, it is important to trust your surgeon and ask as many questions as necessary before any surgery. A good surgeon should take the time to explain each procedure, and also allow for questions.