Excision vs. Destruction

Surgery for 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 and destroy 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.

There are now at least six studies from around the world that show that for early disease that is superficial 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.

We at Boston Children’s Hospital and Brigham and Women’s Hospital utilize both destruction and removal of isolated lesions for early stage disease and excision for disease that is deeply infiltrative or fibrotic. 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.

Wright J, Lotfallah H, Jones K, Lovell D. A randomized trial of excision versus ablation for mild endometriosis. Fertil Steril 2005;83:1830-6.

Abbott J, Hawe J, Hunter D, et al. Laparoscopic excision of endometriosis: A randomized, placebo-controlled trial. Fertil Steril 2004;82:878-84.

Healey M, Ang C, Cheng C. Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation. Fertil Steril 2010, in press.

Last updated: 11/29/17