Patient Outcomes

Following specialist excision surgery with Dr. Cook, the vast majority of patients achieve lasting relief of their pain without recurrence.
  • Dr. Cook’s patients are followed up long-term to evaluate treatment success rates and to monitor their ongoing progress.
  • Of all of our patients, two-thirds reported an ongoing reduction of symptoms of at least 75% and over half of our patients reported over 90% improvement in their pain.
  • In the vast majority of patients, a single laparoscopic surgery with Dr. Cook was sufficient in removing all disease without recurrence or need for reoperation.
  • Of all of Dr. Cook’s endometriosis patients from the past decade, only 17% required repeat pelvic surgery and under 10% were found to have recurrent or persistent endometriosis.
  • We appreciate that surgery may only be one piece in an evolving puzzle to restore a patient’s health. We therefore offer a range of individualized therapies in addition to surgery to help achieve optimal relief in all of our patients.
  • Many of our patients have suffered for years from this debilitating disease and have undergone multiple previous failed surgeries before coming to us. We are committed to helping you on your journey to recovery each and every step of the way, no matter what it takes to achieve success.

Naturally, some of the first questions you are going to ask when looking for surgery for endometriosis are “what are the chances of this surgery actually helping me?”, “How long can I expect to have relief of my pain?”, and “Will this surgery cure me of my endometriosis?” While these are obviously very important questions to be asking, it can be hard to get a straight answer. Your surgeon may be unable to provide you with an overview of his or her follow-up data or whatever he or she can provide may be difficult to interpret.

At Vital Health Institute we want to know how our patients progress so that we can be confident that our treatments are effective. For this reason we regularly follow-up with all surgery patients to keep track of their progress, prognosis and outcomes. By doing so, we are not only generating important data for research, but also are able to provide you with an honest and accurate reflection of what you can realistically expect after undergoing endometriosis excision surgery with us. Our follow-up data enables you to make an informed decision about your treatment options.


When it comes to the treatment of endometriosis, how do we measure success?

Many women with endometriosis find themselves in a seemingly endless cycle of failed medical and surgical therapies. The benefits are short-lived, the painful symptoms return and yet another course of treatment begins. Dr. Cook and his team at Vital Health seek to end this cycle by offering a unique approach to treating this disease. Extensive experience and expertise in the meticulous surgical removal of endometriosis is combined with a comprehensive integrative approach to successfully restore your health.

So how do we measure our rate of success? When patients come to us for treatment, we begin by carefully assessing their symptoms. This process of assessment does not end at surgery but is ongoing in the form of patient follow-up by phone and questionnaire. This allows us to keep track of how our patients are doing long-term. We have been carefully following-up our patients for over a decade, providing an accurate picture of our post-surgery success rates. There are only a few centers worldwide that offer a similar follow-up process and typically the results are only revealed in medical circles and not made transparent to patients. Due to lack of follow-up, most surgeons simply have no idea how well their patients are doing beyond the initial post-operative check-up.

Why is follow-up important? Firstly, it means the door is always open to past patients should they encounter problems in the future. We do not turn our backs on our patients. Secondly, we are able to refine the treatments we offer and develop an understanding of the optimal “recipe for success” in treating a range of patients with pelvic pain. It enables us to learn more about our patients and about endometriosis. Simply, the better our understanding the better we can help. Thirdly, and lastly, our follow-up process allows us to provide prospective patients with objective and realistic success rates in terms of symptom relief and need for reoperation. We appreciate that when making decisions about health care it is of the utmost importance that the patient is as fully informed as possible about what to expect not only during treatment but also in the long run. This fosters trust and confidence. Nothing could be more relevant than in the case of endometriosis treatment, where patients often feel like they have been let down or misinformed by their healthcare providers.

What do our success rates show?

Our patient follow-up provides answers to the following questions:

Patients were followed up from anything from 3 months to 12 years following their surgery with Dr. Cook. Each patient was routinely asked to rate her percentage of improvement in symptoms since surgery. For example, 0% improvement would mean no improvement whatsoever following surgery and 100% improvement would mean all pain symptoms prior to surgery were now resolved.

We found that two thirds of our endometriosis patients were at least 75% better following surgery with Dr. Cook and over half of patients (55%) reported over 90% resolution of their symptoms. Long-term follow-up revealed that symptom improvement was ongoing regardless of the time lapsed since surgery. In conclusion, for the majority of patients undergoing endometriosis surgery with Dr. Cook, surgery brought about a dramatic long-term improvement in their symptoms. Perhaps even more remarkable is the fact that most of the women seeking treatment with us have already had multiple previous failed endometriosis surgeries elsewhere (3.2 previous surgeries on average with a range from 0 to 20 past pelvic surgeries) and have been suffering for an average of 11 years.

These success rates tell us two important things: Firstly, despite multiple previous unsuccessful surgeries and years of pelvic pain, expert endometriosis surgery can bring hope and relief to many endometriosis patients and is an essential step in the optimal treatment of this disease. Finding a surgeon who is highly skilled and experienced in endometriosis surgery can make all the difference. Secondly, not all pelvic pain is due to endometriosis. A minority of our patients reported persistent pain symptoms despite meticulous removal of all endometriosis. In these patients other conditions in combination with or secondary to endometriosis may be present. In order to achieve optimal results in all patients, surgery is not the only treatment strategy on offer. At Vital Health we treat the whole person and offer excellent surgery combined with an individualized integration of treatment modalities to get to the bottom of your pain and succeed in restoring your health.

In the vast majority of cases, a single laparoscopic surgery with Dr. Cook to meticulously remove all areas of endometriosis will bring about long-term relief of symptoms. 84% of Dr. Cook’s patients did not require further surgery despite ongoing follow-up. When interpreting reoperation rates it is important to recognize that reoperation may not only be indicated to treat recurrent or persistent endometriosis but may also be as a result of other gynecological disorders. For example, a condition that may co-exist with endometriosis is adenomyosis (where endometriotic tissue involves the muscular walls of the uterus). So even if removal of endometriosis has been complete, some patients may later return for surgery to treat other associated pelvic disorders.

With over a decade of follow-up of hundreds of patients we have found a recurrence rate of under 7% following excision surgery with Dr. Cook. Interpreting recurrence rates can be difficult. Given only a relatively small percentage of our patients ever undergo reoperation and given recurrence can only be established via surgery, it is the assumption that patients who are pain-free have no recurrence. Perhaps more accurately we should say that of all our patients who undergo surgery for endometriosis, less than 7% are found to have endometriosis at reoperation and therefore recurrent pain following initial surgery is unlikely to be due to recurrent endometriosis. Another important question is whether recurrence equates to mere disease persistence or true cases of disease recurrence. Was disease missed or has new disease formed since the earlier surgery? Given the low rate of endometriosis detected at reoperation after careful removal of all disease, Dr. Cook’s results suggest that true recurrence is in fact a rare event and in most cases all endometriosis can be successfully treated without recurrence. This may come as a surprise to many readers since most doctors insist that surgery is at best a Band-Aid and that the disease will inevitably return in time (why do surgical results differ between specialists and non-specialists?) As you can see, our success rates, however, beg to differ.

We mention previously that of the small number of centers worldwide that have collected long-term data on their patients, success rates are typically only reported within medical circles. An obvious question you may be pondering is how do Dr. Cook’s surgical success rates compare with those of other world-renowned endometriosis surgeons, published in the scientific literature. The answer is that our results concerning reoperation and disease recurrence rival those published by predecessors in the field [1,2,3]. Dr. Cook takes pride in providing his patients with the best surgical care available.

Graphical representation of surgery outcomes:

Reoperation and recurrence rates

Reoperation and recurrence rates following surgery with Dr. Cook. Note that patients who come to Dr. Cook for surgery have already had an average of 3.4 previous procedures for endometriosis.

Percentage improvement following excision surgery

Percentage improvement in pain and other symptoms following excision surgery with Dr. Cook. Note that many patients who come to Dr. Cook have co-existing conditions besides endometriosis that may be contributing to their pain. Bearing in mind that the average patient we see has had multiple previous failed surgeries and has suffered from pelvic pain for over a decade, it is remarkable that the significant majority of our patients achieve complete or near complete resolution of their pain. Endometriosis is considered a chronic incurable disease. Our results show that with the right care, most patients can enjoy a vastly improved quality of life.

References:
1. Wheeler, J. M., & Malinak, L. R. (1987). Recurrent endometriosis Contributions to Gynecology and Obstetrics, 16, 13-21.
2. Redwine, D. B. (1991). Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertility and Sterility, 56, 628-634.
3. Abbott, J., Hawe, J., Hunter, D., Holmes, M., Finn, P., & Garry, R. (2004). Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertility and Sterility, 82, 878-884.