5 Important Facts about Excision

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The information on my platforms is educational information only and not medical advice. Always check with your qualified medical professional before making any changes to your treatment plan. Keep in mind that while I strive to share evidenced-based information on endometriosis, this doesn’t always mean that my information is accurate or complete. See my full disclaimer here.

Excision surgery requires a high volume, expert excision surgeon

Excision surgery is renowned in the field as being an extremely difficult gynecological surgery, requiring a high skill level to remove endometriosis from the delicate tissues, as well as separate organs that may have fused together due to adhesions. For example, the patient may have an obliterated cul-de-sac (the intestines fused to the uterus), ovaries stuck to the uterus, or the intestines fused to the pelvic sidewall. It takes careful skill to be able to tackle the complex surgical challenges that endometriosis presents. This includes not only being able to recognize and excise endometriosis, but to do so safely, without causing compromising organ function or causing the patient long term complications.

The majority of gynecologists do ablation surgery, not excision. It’s estimated that there are only about 500 excision surgeons in the world, even though this disease affects an estimated 200 million people worldwide! There are many barriers to access excision, such as cost, location, insurance hurdles, long wait times, or lack of a referral due to inadequate education among doctors that excision is indeed the gold standard for care. Unfortunately, excision remains a privilege that the majority cannot access instead of being the standard of care that everyone can access, and this is unacceptable, disgraceful, and heartbreaking.

Your endometriosis isn’t “too risky” to remove

Patients with endometriosis on the bladder, intestines, diaphragm, etc, commonly hear this from non-expert surgeons, who tell them their case is too “complex”, “risky”, “complicated” or that their endometriosis in “inoperable”. Typically though, this speaks to the surgeon’s skill level and not your particular endometriosis. What is too risky for one surgeon likely isn’t another with a higher skill level.

It’s important that if the surgeon feels they can’t safely excise from a certain location, like deep disease, or on the bowel, diaphragm, lungs, etc, they should know when to recognize their limitations and refer the patient to a more expert surgeon. We don’t want a surgeon to operate on us that doesn’t have the skills to do so, and then we end up with complications. But what often ends up happening is that instead of saying “This is too risky for my skill set”, the surgeon says “Your endometriosis is too risky to remove” and patients believe that they are beyond help – which isn’t true. High volume surgeons remove deep disease and extrapelvic disease every day. If your surgeon says your case is too complicated, look for a second opinion.

See my page on how to find an excision surgeon. 

Excision is not a cure or a magic wand

While many people find that their endometriosis pain significantly reduces and their quality of life improves post-excision, there are no guarantees. What “quality of life” improvements look like varies: Some patients find that excision eliminates some or most of their symptoms. Others find that excision reduces all of their symptoms but doesn’t eliminate them completely. And unfortunately, not all patients have pain/symptom reduction, or sustained reduction, from excision.

Additional excisions

Some may need a second excision surgery or more, since recurrence is possible – even in the hands of the top tier surgeons. Persistence/recurrence rates tend to be lower among more experienced excision surgeons, but all surgeons have persistence/recurrence. Recurrence can depend on the surgical technique, the surgeon’s skill, the completeness of the excision, the type of endometriosis, location of the lesion, patient’s age, patient’s genes, the length of time post-excision, and other factors.

See my page on Endometriosis Recurrence.

Excision surgery is just one step

Because endometriosis is a complex inflammatory condition that can affect the full body, making patients find that addressing the disease from a full-body approach with excision as the surgical cornerstone gives the the best improvements in their quality of life. 

This often includes addressing our pelvic floor, diet, lifestyle, sleep, hormonal health, digestive health, mental health, and more.

See my pages on non-surgical options and full body approach.