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Video: Why Did My Endometriosis Surgery Fail – Part 1

Coagulation Surgery versus Wide Excision Surgery

Why is it so common to have an endo surgery fail? Could it be traced back to the type of surgery that is being performed, whether it’s Coagulation Surgery or Wide Excision Surgery?

Sometimes, it’s unfortunately not until a person has had several failed surgeries that she finally asks what the difference is between Coagulation Surgery and Wide Excision Surgery?  Or what the advantages and disadvantages of Coagulation Surgery and Wide Excision Surgery are?  Below, we will answer all of these questions for you as we watch part 1 of 3 in the “Why Did My Endo Surgery Fail?” series from Dr. Andrew Cook.


On average, by the time patients get to see me they’ve been through three or four surgeries previously. So a common question I get is “why did my surgery fail?” And, there’s a lot of reasons, but one reason that we – and the reason we’re going to talk about today –  is that it was an outdated coagulation (or burning kind of) surgery. And so I want to talk briefly about

What is coagulation surgery? and  What is wide excision surgery? and what are the differences between these two types of surgeries.

Coagulation surgery uses electrosurgery to burn the tissue. The problem with that is it’s very imprecise. There is also a lot of lateral spread of heat so the very center part (of the affected tissue) – it’s black – it’s a “crispy critter” (it’s dead). The tissue next to it there is what is called a “zone of necrosis”. It looks okay but it’s been heated enough that it’s dead. And so, in the pelvis where there’s endometriosis you have to make sure to stay away from any critical structure of the ureters blood vessels, bowel, bladder, that kind of stuff. And so the advantage of coagulation surgery is – “it is pretty easy, you just stick the thing in there and burn it a little bit and it doesn’t take too long”.

High recurrence rate and other disadvantages of coagulation surgery for endometriosis

The disadvantages are we now know that in the majority of cases it doesn’t remove all the endometriosis and so there’s a high recurrence rate with a coagulation surgery. It damages the tissue so the tissue that’s left behind is damaged, inflamed and – from what we’re starting to understand with how pain works with endometriosis – it may actually make that part of the condition worse (more painful).

What’s the difference between excision surgery and wide excision surgery?

Next, we’re going to talk about wide excision surgery. I’ve been asked, “What’s the difference between excision and wide excision?”

Excision means “to cut out or to remove”. Wide excision means we’re going to take a border of normal-appearing tissue. The inside of the body is lined by the peritoneum (you can think of it like Saran wrap that covers everything – there’s no skin inside) and if we had endometriosis, it could be thought of to be like chia seeds on the Saran wrap. Wherever the endometriosis has spread we need to make a cut surrounding all the peritoneum that has endometriosis, lift the edge up, and cut it out  – that’s wide excision.

Just like if you had a mole, you know the doctor wouldn’t burn it or cut right around the little edge of it, but he’s going to take some normal tissue because if it (gets tested and) does come back as being cancerous, then we all want to know, “Did you get it all?”

And just so you know, endometriosis is not a cancer but we do have to get it all (to consider the surgery a success).


Why doesn’t everybody do excision surgery?

So why did why doesn’t everybody do wide excision surgery

There are several reasons:

  • Wide excision takes a much higher technical skill level
  • wide excision is not really a skill that’s taught routinely in that residency programs
  • wide excision surgery does take longer


The advantages of wide excision

  • lower recurrence rates of endometriosis
  • wide excision surgery usually gets all the endometriosis
  • there’s little or no conduction of heat so the tissue that’s left behind is good, healthy tissue and we’ve removed any excess nerve growth in the area.
Why Did My Endometriosis Surgery Fail - Part 1: Coagulation Excision
Why Did My Endometriosis Surgery Fail - Part 1: Coagulation Excision

Coagulation Excision - Part 1 of 3 in the "Why Did My Endo Surgery Fail?" series from Dr. Andrew Cook.

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  1. Please advise on adhesions been though several laparoscopic operations and had a bad one last November whereby my intestines got torn was put colostal bag for 2 months and was reversed in February but the had come back and now i leave with a lot of pain.

    Thank you.

  2. When the tissue on the back of the abdominal wall has been Ablated and the patient (Myself) has been left with constant pain on that side of stomach where they did this to me will it eventually heal and the pain go away or at least improve? Since my surgery nearly 3 months ago where I had my excision and Ablation I have been left in terrible pain in the area where they did they most Ablation which was all down the left hand side of my abdominal wall. The anxiety it is causing me is out of control as I’m 41 years old have have already had a life time of pain and suffering from back fractures, pericarditis pain (scar tissue left around the heart) Endometriosis and now this. As a mum of two very busy kids and a business owner of a very busy party store I’m so scared I’m going to be left in this state forever. It’s affecting my mental Health. It would be great to hear from others that have had this done and ended up in this state and gradually got better. I don’t think it helps that it took 20 years of complaining about severe period problems, infertility issues and iron infusions for the doctors to finally put me on the waiting list to see what is going on.Thanks everyone.