Endometriosis Surgery: Ablation v Excision – Which is Better?

I’ve had both, ablation surgery and excision surgery for my endometriosis. What’s the difference between the two? Which is supposed to be better? How was my experience with both surgeries? I share this and everything else I know about the two laparoscopic procedures in this post.

Before I continue, please remember that I am not a medical professional. I am a patient who has experienced both surgeries and I’m just sharing what I’ve experienced. Please seek an endometriosis specialist doctor for your personal case.

If you would like to see a video version of this post then you can here, otherwise just scroll through 🙂

As usual, let’s begin with two basic questions:

What is Endometriosis?

To explain briefly, endometriosis is when the lining of the uterus is found growing outside the uterus. And as explained by Dr Abhishek Mangeshikar, an endometriosis specialist a few days back in my chat with him, he said:

“under the influence of hormones there is inflammation which produces new blood vessels and which causes the capillaries in the surrounding tissue to rupture (bleeding) which leads to a cycle of repeated tissue injury and repair every month (fibrosis and scar tissue).”

We also need to remember that endometriosis can be found growing on multiple organs, which makes it a very tricky and an extremely painful, life-altering disease to deal with.

How is Endometriosis Diagnosed?

There are various symptoms that can indicate endometriosis, such as painful periods, irregular period cycles, painful sex, heavy bleeding, infertility and many other symptoms.

You can have an MRI, a transvaginal scan and/or an ultrasound along with pain mapping down by your gynaecologist, but neither the symptoms or these tests can confirm 100% that symptoms are related to endometriosis.

The indications can be strong, but again, it’s not a confirmation.

At the age of 11, I was treated as if I had endometriosis based on my symptoms, but the diagnosis wasn’t confirmed until I was 18 when I had my laparoscopy.

And yes, the only way to really confirm endometriosis is through a laparoscopic surgery.

Relevant Read:

• Tips: How to Manage School Work, Bullying and Endometriosis
• My Experience: Endometriosis v PCOS
• Can Endometriosis Kill You?

Surgical Options for Endometriosis

Like I mentioned, the only way to confirm endometriosis is through laparoscopic surgery in which suspected tissue is removed and tested.

This surgery isn’t just a form of diagnosis, but a form of treatment too.

But now there are two types of surgery for endometriosis – Ablation and Excision.

Which one is better? Which gives long lasting results? Which is more invasive? – let’s try and answer all these…

Ablation Endometriosis Laparoscopic Surgery

Endometriosis ablation laparoscopic surgery, to explain in simple terms is when the diseased areas are burned on the surface through a laser.

What this means is that diseased areas are still left behind because they’re not removing them from the root, it’s just on the surface of it all. This also leads to thick scar tissue forming and in many cases, women end up suffering pain because of this scar tissue.

Also another issue with this ablation form of surgery is that there is a larger chance of the disease coming back, typically 1 to 2 years.

For me, I had this surgery when I was 18 and within four months I was in a state worse off than before. The only good thing this ablation surgery did for me was confirm my endometriosis, otherwise I ended up struggling more than ever with periods that went on for over a month sometimes.

But that’s my case and we’re all different. Our endometriosis will be in different areas, our comorbidities will be different and all of that plays a role in how we handle any such procedure.

The benefits of a laparoscopic ablation surgery is that it’s not too invasive, so the recovery time is less and the incisions are small too

Very importantly for many is that this type of surgery isn’t as expensive as excision surgery, which I will get into a little later on.

One thing that does concern me in general about ablation surgery for endometriosis is that regular gynaecologists are performing it as well. Gynaecologists who don’t necessarily have enough training when it comes to endometriosis.

And those who do have endometriosis training and are specialists, they will usually advise excision surgery, which is what I’ll explain next.

Excision Endometriosis Laparoscopic Surgery

Endometriosis laparoscopic excision surgery, also known as LAPEX has small incisions done but it is definitely more invasive, has a longer recovery time, is performed by an endometriosis excision specialist surgeon, is more expensive and most importantly, it provides long-term relief.

But what’s so different about this surgery?

With ablation we find the disease being laser burned on the surface which leaves the roots of the disease behind, whereas in excision surgery, as the name suggests, the disease is excised.

To explain it in non-technical terms, the diseased tissue is scooped up from its roots in the hope to reduce the possibility of its recurrence.

This is more invasive because it digs deeper, which then means it takes a lot longer to recover from.

It’s been a year now since surgery and I am still recovering – that’s because I have Ehlers-Danlos syndrome, which makes me a slow healer but I AM recovering and that’s most important.

Plus the surgery has made me feel so much better, which I’ve spoken about here:

• One Year on from Endometriosis Excision Surgery – Was it Worth it?

If you wish to know the cost of excision surgery, how I prepared for my endometriosis excision surgery, what I did for post-surgery recovery and how my first six months after surgery went, then check out these posts:

• How Much Does Laparoscopic Endometriosis Excision Surgery Cost?
• My Guide: How To Prepare For Endometriosis Laparoscopic Excision Surgery
• My Guide: What To Expect After Endometriosis Excision Surgery
• Six Months On: Endometriosis Laparoscopic Excision Surgery – Am I Better?

So What’s Better? Ablation or Excision Surgery for Endometriosis?

In both types of surgery, endometriosis can come back – but excision surgery should give you a much longer remission time. The reason I’m not stating how many months or years is because we all have our endometriosis troubling various different combinations of organs and we’re also, most likely not seeing the same specialist surgeons – and yes their skills vary.

But excision surgery gives us a better chance, it’s the gold standard in treating endometriosis – only if we see an endometriosis excision surgery specialist.

I hope this information helps in understanding the difference between the two types of surgeries in the most simplest ways.

Good luck on your journey with managing endometriosis.

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Disclaimer: I am not a medical professional. I am a patient and have created this platform to share my experiences. This is all purely informative and in no way am I providing medical advice. Please consult a medical professional.