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Endometriosis Surgery: Ablation/Coagulation laparoscopy vs Excision laparoscopy. What is the difference?

Having laparoscopic surgery for endometriosis is the only way to truly diagnose endometriosis. In this blog post I’ll share the facts about ablation/coagulation laparoscopy and excision laparoscopy so you can tell the difference. We touch on truths about each type of endometriosis surgery as well the best treatment for endometriosis, medication or surgery.

 

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What Is Endometriosis?

Endometriosis is not just painful periods. Endometriosis is a full body inflammatory disease with an immune component. The endometriosis lesions are similar to the tissue that lines the uterus, however, they are outside of the uterus. The lesions are hormone sensitive and respond to the hormones of the menstrual cycle, but, endometriosis is not caused by excess estrogen! Click here to read more about endometriosis



Endometriosis Surgery: Ablation/Coagulation Laparoscopy

Ablation/coagulation laparoscopic surgery is a surgical technique that uses burning/ablation, coagulation and other superficial approaches to remove endometriosis lesions from the surface of organs.


This type of surgery is considered a limited surgery because it is common for the bulk of endometriosis lesions to be left behind. If you can imagine endometriosis lesions like weeds, this type of surgery only removes the weed along the surface and leaves all the roots behind. 


Ablation/coagulation laparoscopic surgery causes “scarring or charing” on the surface of the organs leading adhesion formation (where organ and tissues stick together). These adhesions cover up the endometriosis that was left behind, and disease covered by new adhesions increases pain post op.


Ablation/coagulation laparoscopic surgery routinely results in poor outcomes and requires re-operation in the future to remove the adhesions along with the endometriosis lesions that have been left behind.


There are many names for this type of surgery. You may have heard ablation, electrical fulguration, cauterization, and or laser, however, the outcomes remain the same. 


Sadly, this type of surgery remains the most commonly performed approach to endometriosis surgery leaving many women at a loss and still in pain.



Endometriosis Surgery: Excision Laparoscopy


The term excision means that lesions are removed along with the borders of surrounding healthy tissue, making the patient essentially disease free. Each lesion is removed individually without the use of any energy or heat, to preserve the tissue so it can be sent to pathology to be analyzed for a proper diagnosis. The anatomy is then restored and any affected organs or tissue is repaired and reconstructed so that function is retained.


Excision surgery is the gold standard of endometriosis surgery.


Excision surgery is recommended over any other surgical method (ablation/laser) due to their destructive methods. Excision is the most effective way to treat endometriosis because it doesn’t destroy the tissue, it removes the diseased and inflammatory tissue down to its roots and the normal healthy tissue is reconstructed and repaired so they function fully. 


Seckin MD notes that there are only a handful of doctors that perform this type of surgery at this time. “Learning and refining the procedure requires lots of experience, knowledge, time, precision, dexterity, and patience.”


Excision laparoscopy also has the best surgical outcomes in terms of pain relief for patients! 75-85% of women who undergo excision surgery experience long time pain relief!


Read more about excision laparoscopy from The Center for Endometriosis Care here


The Best Treatment For Endometriosis: Medication or Laparoscopy?

Excision laparoscopy remains the gold standard of treatment for endometriosis. It removes the diseased tissue to be sent to pathology, which not only helps the patient with a diagnosis, but also helps research efforts. It also has greater surgical outcomes in terms of long term pain relief!


Pundir said that 12 months post surgery, symptoms of painful periods, painful bowel movements, and chronic pelvic pain due to endometriosis showed a greater improvement with laparoscopic excision vs ablation surgery! Read that article here


However, the medical community is routinely taught that the best treatment is medical suppression and ablation/laser surgery. This is due to a lack of research in endometriosis and a lack of education in the medical field. This is why we have to be our own best advocates.


The Center for Endometriosis Care has stated that medication does not eradicate endometriosis, and is not a treatment for endometriosis. Read that article here  Basically, medication cannot remove the inflammation, inflamed tissue, diseased tissue, endometriosis lesions, and adhesions that are causing you pain. At best, it might provide you temporary symptom relief. However, more often than not, the side effects are negative and can last long after the medication has been stopped.


An article review of the current diagnostic tools and therapies for endometriosis also stated that medication and hormonal suppression has “no effect on adhesion of endometriosis cells and cannot improve fertility. Nonetheless, a number of hormonal agents remain the mainstay of endometriosis treatment”. Read the article here


There you have it! The truth about ablation laparoscopy vs excision laparoscopy!


Tell me about you! Have you had laparoscopic surgery for your endometriosis? How are you feeling?


Chelsea Donahue | Endometriosis Coach 


Instagram: @chelseaaabri

Email: chelseaaabri@gmail.com



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1 comment

  • Hi. Thankyou for sharing your experience and knowledge. I was diagnosed with endometriosis about a year and a half ago. I was never sent to hospital for a proper examination, but my gyno was convinced of the diagnosis and immediately prescribed me contraceptives. I have been on the pill for about a year and I have gained about 10 kg and I’ve had trouble controlling my diet and my mental health ever since. I’m wondering if I should try to get my general practitioner to agree to Excision laparoscopy but i’m not even sure if it’s offered through national health services in Norway, where I live. The pill has done the trick by suppressing the disease but I just don’t feel good dealing with the side-effects of it.

    Tessa

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