“I had excision surgery but did not obtain relief. Was my surgery a failure?”
Almost all centers that specialize in Endometriosis, in and out of the USA, perform excision. Even after excision, endometriosis, adhesions, and pain can persist and/or recur, and need further treatment later on. Excision gives the best chance for long-term pain relief, and minimizes the need for repeat surgeries.
Abdominal, pelvic, back pain can have many sources, including but not limited to, Endometriosis, Pelvic Inflammatory Disease (PID), Interstitial Cystitis (IC – chronic pelvic pain of bladder origin), Inflammatory Bowel Diseases (IBD) – Chronic Ulcerative Colitis and Crohn’s Disease, Irritable Bowel Syndrome (IBS) with Constipation, Diarrhea and Abdominal Bloating, and Neuromuscular Pains including conditions such as Fibromyalgia. Coexisting Tick-born diseases such as Lyme will also increase pain associated with all these conditions.
Sometimes after laparoscopic excision, none of the specimens are confirmed as endometriosis on pathology, but the patient feels great. I excise areas that look abnormal, areas that are scarred and fibrotic, and/or are in locations that correlate well with the distribution of pain that the patient is experiencing. Sometimes after laparoscopic excision, some, most, or all the specimens are positive for endometriosis on pathology, but the patient still has pain. In that individual, there must be some other factor at work that is causing her pain. Therefore, it is not just whether the person has endometriosis, but whether endometriosis is the root cause of the pain.
Pelvic floor muscles respond to chronic pain conditions. Even after the disease is thoroughly removed some patients need Physical Therapy / Biofeedback. Physical Therapy has a better chance of being successful after the underlying cause for the pain is removed. To have the best chance for pain relief, we need to treat the whole person and eliminate All Sources of Pain that we can identify.