Ablation or Excision? Technical Stuff with Endo, but with Very Different Outcomes
Last updated: January 2023
Ablation or Excision? Both sound scary right? Anything with mystery words like this can be. But how do you know which is right for you? Both of these terms were thrown around in a recent OBGYN appointment and this left me confused and anxious, so I sought to do my own research to learn more about each.
Candidates for endometrial ablation
Typically they have very heavy periods that get in the way of everyday life. This can include having to change your tampon/pad every hour to debilitating cramps that cause you to double over in pain for hours. Sound like you? Maybe this is the answer. This is a procedure, but it is NOT surgery. Endometrial ablation can be done in the gynecologists’ office or at an outpatient surgery center. There is no general anesthesia, just a local numbing injection to ease any discomfort that may be experienced. (Definitely not for the faint of heart). Typically, a thin tube is inserted into the vagina and either a balloon with heated water is filled or the uterus itself is filled with heated water in an effort to destroy the endometrial lining that is currently in place. By removing this lining manually with heat instead of waiting for it to naturally shed during a menstrual cycle, the lining can be made thinner by destroying the currently thick layer that contributes to cramping and heavy blood release. Once the lining is broken up, it will be shed over the next few days as part of recovery. Whoever is performing the procedure does not remove the lining or take any tissue samples. Everything is left in place will be shed as part of the recovery process.
Recovery takes about a week and most women notice the effects immediately. Unfortunately the downside is that endometrial ablation doesn’t always last. The lining can build up to a thick layer again from a couple months to a few years, depending on the severity of the endometriosis. You can never know the severity of the endometriosis unless exploratory surgery is performed to look around and see where the endometriosis is growing and the extent of its growth.
Endometrial ablation is great for those that are not afflicted by more serious endometriosis. But if you are unfortunate enough to be 1 of the ones with a more serious case of endometriosis (like me), excision maybe a better treatment option. While this procedure does not determine what stage endometriosis you are in either, it can help to alleviate symptoms by removing the effected tissue.
Endometrial excision should only be performed by a trained surgical excision specialist. This procedure is performed under general anesthesia in a hospital. If your doctor claims they can do this in the office with a local, run and get a second opinion immediately. Endometrial excision surgery targets the specific endometriosis lesion. The excision specialist will cut out the diseased tissue for further pathological examination. By cutting out the diseased sections (similar to that of cancer removal), there is a lower chance of reoccurrence in the same area unless the surgeon does not completely remove the diseased piece of tissue. If this is the case, then endometriosis can grow back in that same spot in just a matter of time. By removing the entire diseased tissue section, the likelihood of reoccurrence is greatly reduced and subsequent pain relieved. (We all want pain relief).
Endometriosis typically only attacks the female organs, but in a small percentage of the population, it can invade other areas like the intestines and bowels. This is considered advanced (progressed) endometriosis and requires more extensive excision and potentially the partnership with a colorectal surgeon who specializes in endometriosis removal as well. Each lesion that is removed can have its own pathology life and report. One lesion can be malignant and another benign for cancer. Therefore careful examination of each lesion is required by a trained pathologist. Excision essentially completely removes the diseased tissue which if completely removed should never grow back in that same place. This is why only going to a well-trained excision surgeon is key. If they miss any part of the diseased tissue, endo will grow back in the same spot wreaking havoc. (Also something I learned the hard way).
All procedures carry some risk
Even if they are performed in the doctor’s office. Risk of infection is the number one complaint from a procedure in addition to some pain and discomfort afterwards. Being able to recognize these signs and symptoms are key since you likely will be recovering at home without medical supervision. Fever, chills, heavy bleeding, abdominal cramping and trouble urinating are key signs that an infection maybe present. Definitely contact your doctor right away if you experience any of these concerns post procedure.
Whether you are having ablation or excision, ridding your body of endometriosis as soon as possible will be the best outcome since it has been noted as a progressive disease that can contribute to worsening health outcomes the longer that it is ignored. No one wants to live with chronic pain that interrupts various aspects of your life. Addressing any symptoms you are experiencing including long term options can help to improve overall quality of life.
Bottom line...Do you research and question your doctor's thought process. Advocate for yourself, not all doctors will. Had I not done my own research on the difference in terms and treatments, I might be in worse shape than I am today by having a temporary fix to a permanent or larger problem. It pays do your own research and ask questions, lots of questions of these medical professionals. Sometimes it means getting a second, third or even fourth opinion to find someone with your best interests and health at heart.
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