ESSI Endometriosis: Frequently Asked Questions (FAQ)

If you are suffering from endometriosis, you have likely spent hours scouring the internet for answers, only to find conflicting advice, outdated medical opinions, and dismissive attitudes.

At Endometriosis Surgical Specialists International (ESSI), we believe that empowered patients make the best medical decisions. Our multi-coastal team of experts—including Dr. Andrea Vidali, Dr. Osbert Fernandez, Dr. Daniel Cibulsky, Dr. Madhu Bagaria, Dr. Mallory Stuparich, and Dr. Alessio Pigazzi—has compiled this definitive FAQ to clear the confusion and help you reclaim your health.

1. What is Endometriosis, really?

Most standard medical websites describe endometriosis simply as “the lining of the uterus growing outside the uterus.” This is biologically inaccurate and minimizing.

Endometriosis is tissue similar to the uterine lining that implants elsewhere in the body (usually the pelvic cavity, but it can reach the bowel, bladder, diaphragm, and nerves). It is a highly inflammatory, estrogen-dependent, systemic immune disease. These lesions create their own blood supply and nerve networks, turning into microscopic pain generators that trap major pelvic nerves in dense scar tissue (fibrosis). It is not “bad cramps”—it is a complex, whole-body disease.

2. My ultrasound and MRI were “normal.” Does this mean I don’t have endometriosis?

No. This is one of the most dangerous myths in women’s healthcare.

Standard transvaginal ultrasounds and pelvic MRIs often completely miss superficial endometriosis and even deep infiltrating disease if they are not read by an expert. Endometriosis lesions can be microscopic, clear, or flat, making them invisible to standard imaging. A “normal” scan does not invalidate your pain. The only definitive way to diagnose and treat endometriosis is through specialized laparoscopic excision surgery.

3. Is a hysterectomy a cure for endometriosis?

Absolutely not. A hysterectomy (removal of the uterus) cures adenomyosis (disease within the uterine muscle), but endometriosis exists outside of the uterus. If a surgeon removes your uterus but leaves endometriosis lesions on your bowel, bladder, or pelvic sidewalls, your pain will persist. At ESSI, we specialize in Uterine and Fertility-Sparing Excision. We believe you should not have to sacrifice your reproductive organs just to get relief from pain.

4. What is the difference between Ablation and Excision surgery?

This is the most critical question you can ask your surgeon.

• Ablation (Burning): Used by the vast majority of general OBGYNs. The surgeon uses a laser or heat to burn the surface of the lesion. This leaves the deep, fibrotic roots intact and creates additional thermal scar tissue, trapping nerves and practically guaranteeing the pain will return.

• Excision (Cutting): The ESSI standard. Our surgeons meticulously cut around and beneath the lesion, physically removing the disease from your body by its roots, much like removing an iceberg.

5. Why do I need a multidisciplinary team for my surgery?

Because endometriosis does not respect the boundaries of your reproductive organs.

If a solo gynecologist finds endometriosis infiltrating your rectum or colon, they often have to leave it behind because they are not trained in bowel resection. At our ESSI West Coast hub, Dr. Mallory Stuparich (Advanced Robotic GYN) operates concurrently with Dr. Alessio Pigazzi (World-Renowned Colorectal Surgeon). On the East Coast, our high-volume team is equipped to handle the most complex pelvic anatomy. If the disease is on your bowel, bladder, or nerves, we have the precise expert in the operating room to remove it safely in one surgery.

6. How does endometriosis affect my fertility and IVF?

Endometriosis doesn’t just cause mechanical blockages (like blocked fallopian tubes); it creates a toxic, inflammatory environment in the pelvis.

This inflammation can degrade egg quality, interfere with embryo implantation, and cause the immune system to mistakenly attack a healthy pregnancy, leading to recurrent miscarriage. This is often called “Silent Endometriosis”—when a patient has no classic pain symptoms but experiences repeated IVF failures.

The ESSI Solution: Dr. Andrea Vidali integrates Reproductive Immunology directly into your surgical care. Furthermore, you will work one-on-one with our Senior Embryologist and Reproductive Biologist, Emanuela Lazzaroni Tealdi, MSc. Ema will help create a highly personalized Reproductive Endocrinology and Infertility (REI) plan to calm your immune system, optimize your uterine environment, and protect your ovarian reserve post-surgery.

7. I live out of state and the waitlists near me are 9–12 months. Can I travel to ESSI?

Yes. In fact, over 60% of our patients fly in for surgery.

Many local hospitals and academic systems are fantastic institutions, but they are often bogged down by massive waitlists and institutional red tape. You do not have to wait a year in agony while your disease progresses.

We have perfected the “One-Trip” Protocol for out-of-state patients:

1. Virtual Consult: You meet with your ESSI surgeon (Dr. Vidali, Dr. Fernandez, Dr. Cibulsky, Dr. Bagaria, or Dr. Stuparich) via video from your living room. You mail us your imaging, and we review it remotely.

2. The Trip: We block your pre-op testing, surgical date, and initial recovery into a single, organized window.

3. Remote Aftercare: You return home to recover in your own bed, with our team available via telehealth for your post-op follow-ups.

Stop Guessing. Start Healing.

You have questions, and you deserve definitive, biologically sound answers. If you are ready to move past symptom management and get to the root of your disease, our multidisciplinary team is ready to evaluate your case.