Excision vs. Destruction
Surgery for endometriosis, when utilized as one of the “tools to treat endometriosis” has 2 main goals: diagnose the disease and treatment. There seems to be a great confusion in the world of endometriosis as to the best technique to remove or destroy endometriosis.
At the time of a surgical diagnosis, the surgeon notes where the lesions are, if there are adhesions (where tissues and organs stick together), and if the disease is growing deeper from the surface of the abdominal/pelvic cavity. The goal of the surgery is to remove [excise] and destroy [vaporize/ablate] the disease without causing additional harm (damage to organs, blood vessels, or create scar tissue). It should be remembered that there is no surgical cure for endometriosis and the disease can remain/recur no matter what surgical technique is utilized. Some surgeons have promoted the use of “radical excisional surgery” or “peritoneal stripping” as a cure for endometriosis.
Not all endometriosis is the same. Endometriosis has been classified based on the type of lesion and how deep it is growing on or into normal tissue. The lesions can be on the surface structure [Stage I or Stage II] or it can be growing deeper [Stage III or IV] through the surface structures and affecting the deeper structures [deeply infiltrative endometriosis].
There are now at least six studies from around the world that show that for superficial disease there is no difference in follow-up pain when utilizing either excision or destruction. In cases where the endometriosis is growing deeper into tissue/structures of your body, those same studies have shown that it is better to excise or remove the tissue then just to destroy it. A recent report has shown extensive adhesion formation after radical excisional surgery for the treatment of superficial peritoneal endometriosis, and thus we do not recommend these treatments for Stage I or II disease. The American College of Obstetricians and Gynecologists also does not recommend “peritoneal stripping” or radical excisional surgery due to concerns of potential adhesion formation contributing to bowel obstruction, infertility, or both and persistent pain.
We at Boston Children’s Hospital and Brigham and Women’s Hospital utilize both destruction and excision of isolated lesions for early stage disease and excision for disease that is deeply infiltrative or fibrotic. We do not use radical excisional surgery or peritoneal stripping. We individualize each person’s care so that the right technique is used for the right person. We have also done long-term follow-up studies that show that the techniques that we are using do not cause adhesions to form. In addition we have shown that with our surgical technique followed by medical therapy, we can keep the disease from progressing which will help reduce lifelong pain and infertility.
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Last updated: 7/21/19