Understanding Excision and Ablation Surgery for Endometriosis
- Love To Feel Editorial Team
- Jun 17
- 3 min read
Updated: Jul 2
Surgery is sometimes part of managing endometriosis, particularly when symptoms are severe or haven’t improved with other treatments.
Two of the most common surgical approaches are excision and ablation. While both aim to reduce pain and remove endometrial tissue growing outside the womb, they work in very different ways — and understanding those differences can help you feel more informed about your options.
What is Excision Surgery for Endometriosis?
Excision surgery involves cutting out the abnormal tissue. Surgeons carefully identify and remove lesions — including those buried deeper in tissue or attached to organs like the ovaries, bowel, or bladder. Because it removes the tissue entirely, excision is considered a more thorough approach.
This type of surgery is typically performed by gynaecologists who specialise in endometriosis. The procedure may take longer and requires more surgical precision, especially when lesions are in complex areas. Recovery time varies but generally includes a few days of rest, with most people feeling more like themselves within a couple of weeks.
What Is Ablation Surgery for Endometriosis?
Ablation surgery works differently. Rather than cutting out tissue, it uses heat or energy (such as laser, electrical current, or plasma) to destroy the surface of the lesions. The goal is to burn away visible endometriosis tissue and reduce symptoms.
Ablation is often quicker to perform and may be available in more general gynaecological settings. However, it may not fully treat deeper or hidden lesions, as it focuses on surface-level areas. This means that some endometrial tissue can be left behind, which may contribute to the return of symptoms over time.
Key Differences Between Excision and Ablation
Method
Excision: The endometrial tissue is surgically cut out and removed.
Ablation: The tissue is destroyed using heat, laser, or another energy source.
Depth of Treatment
Excision: Can remove both surface-level and deep-infiltrating lesions.
Ablation: Targets only surface-level lesions.
Recurrence Rate
Excision: Lower chance of recurrence due to complete tissue removal.
Ablation: Higher chance of recurrence as deeper tissue may remain.
Surgical Time
Excision: Typically takes longer due to the complexity and precision required.
Ablation: Usually shorter, as it’s less detailed.
Surgeon Expertise
Excision: Performed by surgeons with specific training in endometriosis.
Ablation: More commonly done by general gynaecologists.
Recovery Time
Excision: Recovery usually takes 1 to 2 weeks.
Ablation: Recovery tends to be quicker — often just a few days to a week.
Effectiveness
Excision: More likely to provide long-term symptom relief and reduce the need for further surgery.
Ablation: May ease symptoms temporarily but less effective for long-term control.
What Does the Research Say?
Several studies have found that excision offers longer-lasting relief from pelvic pain and may be more effective at treating deep infiltrating endometriosis. Some research also suggests that excision can reduce the likelihood of needing repeat surgeries.
That said, ablation is still widely used, especially in cases where the disease is believed to be milder or superficial. It may be considered a less intensive option for those in earlier stages of the condition or who are not ready for more extensive surgery.
Why Surgical Experience Matters
Regardless of the method, outcomes often depend on the skill and experience of the surgeon. Endometriosis can be challenging to detect and remove completely, particularly when it affects multiple organs or is hidden beneath healthy tissue. A surgeon who specialises in endometriosis, and has performed a high volume of surgeries, is more likely to identify and treat all problematic areas effectively.
If you’re considering surgery, you can ask your doctor about their experience with each technique, how often they treat endometriosis, and what kind of results they typically see.
Excision vs. Ablation — A Summary
While both excision and ablation aim to reduce symptoms and improve quality of life, they are not interchangeable. Excision is often preferred for more severe or deeply embedded disease because of its more complete removal of tissue. Ablation may be considered when symptoms are milder.
Each method comes with its own benefits and limitations, and the most appropriate approach will depend on individual factors, including your symptoms, medical history, stage of disease, and personal preferences.
Learning More and Seeking Support
If you're navigating treatment decisions, know that you're not alone. Many people with endometriosis spend years trying to find answers, and connecting with support groups or organisation can be incredibly helpful.
Surgery isn’t always the first or only option, but if it becomes part of your care, understanding how it works can give you more confidence in the process and your next steps.
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