Surgery

The two types of surgery

There are two main types of endometriosis surgery: ablation and excision. Both can be done laparoscopically, through 4-5 small incisions in the abdomen.

Ablation

In ablation surgery for endometriosis, the surgeon burns endometriosis lesions using lasers or electrocautery tools. Even though ablation may result in a reduction in pain and symptoms for up to several years, the lesions may grow back or recur.

Excision

In excision surgery for endometriosis, the surgeon cuts the endometriosis lesions out completely.

The research

A 2024 Cochrane systematic review of nine studies found that excision surgery for ovarian endometriosis (endometrioma) resulted in fewer instances of recurrence, compared to ablation surgery.1 They found endometrioma recurrence in 37% of women after ablation but only 5-17% of women after excision. There was no difference in the number of women who got pregnant in the first year after surgery between those who had ablation versus excision, suggesting that excision may not have an impact on fertility. The ovaries are only one place where endometriosis lesions can grow. Whether recurrence is more common after ablation surgery for lesions in other places in the pelvis is still being investigated.

A 2022 systematic review of four studies reported that both ablation and excision surgery were successful in reducing pelvic pain, however.2

Takeaway

While ablation and excision surgery are both effective at reducing pelvic pain, there is less likelihood of recurrence with excision.

References

  1. Kalra R, McDonnell R, Stewart F, Hart RJ, Hickey M, Farquhar C. Excisional surgery versus ablative surgery for ovarian endometrioma. Cochrane Database Syst Rev. 2024;11(11):CD004992. doi:10.1002/14651858.CD004992.pub4
  2. Ouyang C, Fitch A, Cho KS, Driscoll J, Wang A, Lamvu G. Efficacy of excision versus ablation for improving endometriosis related pain: A systematic review and meta-analysis. J Endometr Pelvic Pain Disord. 2022;14(1):52-62. doi:10.1177/22840265221074850

Last updated: August 2026