My Doctor Said It Was All Gone”: Why Endometriosis Comes Back
It is a story we hear in our consultation rooms every single day. A patient sits across from us, exhausted and defeated, holding a stack of surgical records.
“I had surgery two years ago,” they say. “My doctor told me they burned it all off. They said I was ‘cured.’ But the pain is back, and it’s worse than before.”
This moment is heartbreaking, but it is also preventable. If you are in this position, please know: You didn’t fail. Your surgery likely did.
The reason for this “recurrence” usually boils down to one critical distinction in surgical technique: Ablation (Burning) vs. Excision (Cutting).
The Iceberg Effect: Understanding Ablation
For decades, the standard method for treating endometriosis by general gynecologists has been Ablation. This involves using a laser or electrical energy to burn the surface of the endometriosis lesion.
Why is this a problem? Imagine endometriosis is like an iceberg or a weed.
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Ablation burns off the “snow” on top of the iceberg or cuts the leaves off the weed.
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To the naked eye, the surface looks clean. The surgeon tells you, “It’s all gone!”
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But the root remains. The active, inflammatory disease is still alive beneath the tissue, continuing to grow, shed, and cause pain.
Because the root was never removed, the relief is often temporary—lasting only a few months or a year—before the “weed” grows back. This isn’t true recurrence (new disease); it is persistence (old disease that was never fully removed).
The Gold Standard: Understanding Excision
At ESSI, we practice Excision Surgery. This is a fundamentally different approach that requires advanced, fellowship-level training.
How does it work? Instead of burning the surface, an excision surgeon cuts around and under the lesion. We remove the disease, the root, and a margin of healthy tissue around it to ensure nothing is left behind.
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The Gardening Analogy: If ablation is mowing the lawn, excision is digging out the dandelion by its root.
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Pathology Confirmation: With excision, we send the tissue to a lab. A pathologist confirms under a microscope that it is endometriosis. With ablation, the tissue is destroyed, so you never truly know what was burned.
Why Do Doctors Still Use Ablation?
If excision is so much better, why is ablation still common?
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Speed & Ease: Ablation is fast. A surgeon can “burn” a few spots in 20 minutes. Excision is meticulous and can take hours.
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Training: Most OB/GYN residencies do not teach advanced excision techniques. It requires a high level of skill to cut safely near the bowel, bladder, and ureters.
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Safety (for the Surgeon): Burning the surface is less risky for a less-experienced surgeon than cutting deep into the pelvic floor. But this “safety” comes at the cost of your long-term relief.
True Recurrence vs. Persistence
Is it possible for endometriosis to come back even after expert excision? Yes, it is possible, but the rates are drastically lower. Current research suggests that expert excision offers the lowest recurrence rates in medicine.
However, what many patients experience is not “recurrence” (new disease appearing), but persistence—disease that was missed or merely scorched by a previous surgeon who wasn’t a specialist.
Stop the Cycle of Surgery
You should not have to plan your life around repeated surgeries every two years. The goal of endometriosis surgery should be one definitive, expert procedure that gives you your life back.
If you have been told your disease is “back,” it’s time to ask: Was it ever truly gone?
At ESSI, we don’t just treat the surface. We treat the disease at its root.
