ENDOMETRIOSIS FOUNDATION
OF HOUSTON
Treatment: The Gold Standard
Excision Surgery
Laparoscopic excision of endometriosis is the cornerstone of correctly treating endometriosis. Excision allows for the disease to be meticulously removed – cut out – from all areas without damaging surrounding structures or removing otherwise healthy organs.
This procedure requires highly advanced surgical skills, and surgery for endometriosis should be performed only by excision specialists who see a large volume of endometriosis excision cases.
Excision is markedly different from ablation surgery, where the surgeon only burns the surface of the lesion, leaving disease behind. Be aware that while the vast majority of OBGYNs practice ablation surgery, only a handful have been trained using the excision method.
If all endo is not removed at the time of surgery, symptoms will persist. This is why ablation surgery often relegates a person to repeat surgeries and continued pain.
To illustrate, ablation is like mowing weeds. They grow back! Excision, on the other hand, is like digging a weed up by its roots. Once you cut it out, it’s gone.
Excision with a Specialist Surgeon: Advantages vs Disadvantages
Excision with a Specialist Surgeon
Advantages
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Long-term pain relief rates as high as 75-80%
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The only way to completely remove the disease
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Allows for pathology confirmation of disease
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Low rates of recurrence compared to ablation
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More precise treatment
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Less internal scarring compared to ablation
Excision with a Specialist Surgeon
Disadvantages
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More expensive
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Not all excision surgeons accept insurance
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Fewer specialists mean longer wait times
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Longer recovery time
Surgeon Skills
The skill of the surgeon matters. Surgery performed correctly by a highly skilled surgeon who specializes in endometriosis excision surgery is integral to successful and effective endometriosis treatment.
The Pain and Quality of Life Survey commissioned by the UK Endometriosis All-Party Parliamentary Group and presented at the Ninth World Congress on Endometriosis (2005) showed that OB/GYNs who were not endometriosis specialists were ineffective at operating on endometriosis. Of the 7,025 women surveyed, 70% of women undergoing surgery with nonspecialists reported feeling no improvement, and, in some cases, patients reported feeling worse than before surgery.
People who undergo surgery with an endometriosis excision specialist report up to 80% improvements in pain levels, quality of life, and sexual activity (Abbott, Hawe, Hunter, Holmes, Finn, & Gary, 2004).
Similarly, a longitudinal study by Dr. Andrew Cook and the Vital Health Institute followed 600 patients who underwent excision surgery with an endometriosis specialist surgeon (Cook, 2012). On average, patients reported a 75% improvement in symptoms.
The re-operation rate with excision of endometriosis is only 20% - better than the 80% re-operation rate of superficial surgical treatment. Suppression post-operatively is also not needed because - with complete excision - there should not be any endometriosis left to be suppressed.
When excision is used carefully and thoroughly by a skilled surgeon, endo recurrence rates are less than 10%.
Most gyns say they treat endo, but how do you know they perform excision? Ask if they excise, what energy they use to do it, how they treat endometriomas, what they would do if there was endo on the bowel or bladder that was invasive. Have they ever performed a bowel resection? Bladder resection? How often do they convert to open (our rate is less than 1 per 1000 surgeries)? Very few can do both OB and be an excision specialist. I operate 4-5 days a week and couldn't deliver a baby...I'm too busy treating endo.
Dr. Ken Sinervo
CEC Medical Director