Excision vs. ablation, explained.
Two operations are offered for the same disease. They are not equivalent, and the difference is the most useful thing a patient can understand before consenting to surgery.
Ablation burns the surface of a lesion. Excision cuts the lesion out at its full depth, with a margin. Both are done through keyhole surgery, both are called "endometriosis surgery", and only one of them reliably removes the disease.
What ablation does
Ablation destroys tissue at the surface using heat. It is quicker, it needs less technically demanding surgery, and on the operating table it looks like the disease has gone. The difficulty is that endometriosis is often deeper than it appears — a lesion visible on the peritoneum can extend well below it. Burn the top and the remainder stays.
What excision does
Excision removes the lesion in full, cutting around and beneath it. It takes longer, it requires dissecting near bowel, bladder, ureters and nerves, and it produces a specimen that can be sent to pathology — which is also how you get histological confirmation of what you had.
Prototype content. The clinical argument above is broadly right but needs writing properly and reviewing before publication, including the evidence base and the honest limits of it. This page proves the article shape, the byline pattern and the schema.
Why it matters for recurrence
When pain returns after surgery, one common explanation is that disease was left behind. That is not the only explanation — adenomyosis, musculoskeletal pain and central sensitisation all cause pain after a technically good operation — but it is the one most worth ruling out, and it is the one most within a surgeon's control.
What to ask your surgeon
- Do you excise or ablate? If both, when do you choose each?
- Do you send specimens to pathology?
- What happens if you find disease on bowel, bladder or ureter — do you proceed, or stop and refer?
- How many of these do you do a year?
A surgeon who answers these directly is telling you something. So is one who doesn't.
If you've already had surgery that didn't help
Bring your operative reports to a consult. The operative note usually tells us what was actually done — and we will tell you honestly what we see, including when the answer is that more surgery is not what you need.Request a consult →