Endometriosis Surgery Explained: Excision vs. Ablation and Why It Matters
Excision vs. Ablation: Why the Right Surgery Matters for Endometriosis Relief
Wait—these aren’t the same thing?
If you’ve been diagnosed with endometriosis—or you’re still stuck in the frustrating cycle of symptoms with no real answers—you’ve probably heard the terms excision and ablation thrown around like they mean the same thing — they don’t. And understanding the difference is a big deal when it comes to finding lasting relief from chronic pelvic pain.
We get it—navigating treatment options can feel like learning a new language while living in pain. That’s why we’re breaking it all down: what excision and ablation actually mean, how they affect your body, and what to ask your doctor. You deserve answers—and real solutions.
Let’s Define the Players
Excision and ablation are two common surgeries used to treat conditions like endometriosis (tissue similar to the lining of the uterus that’s growing where it shouldn’t be), precancerous cells on the cervix (aka CIN), and even some bone tumors (osteoid osteoma). Though they target the same health issues, the steps look a little different for each one.
Excision and ablation are performed during laparoscopy. A laparoscopy is a minimally invasive surgery where a tiny camera is slid through a small incision in your belly so doctors can see what’s going on inside.
What is Ablation?
Ablation refers to the procedure that zaps off patches of endometriosis. Doctors use heat, freezing, or radio waves, to destroy visible problem spots. It’s not as deep or as thorough as excision, it’s a relatively quick procedure. It can help reduce pain and provide relief for women dealing with surface-level endometriosis.
What is Excision?
Excision surgery is like a full-on detox for endometriosis. During this procedure, a surgeon goes in and carefully cuts out the endo tissue wherever it’s hiding—on your ovaries, bladder, bowels, you name it. Instead of just treating what’s on the surface, they remove the root of the problem, which means they’re aiming to get all of it. It’s a detailed, precise process that takes some time, but it’s known for giving long-lasting relief and improving fertility—especially if your symptoms have been stubborn or severe.
A good way to break down the difference between these two? Think of it like this:
“Ablation is like trimming weeds. Excision is like pulling out the root system.”
What It Means for Your Body
Effectiveness
Excision is generally considered the gold standard for treating endometriosis, but it’s not always easy to get. Endometriosis can come back, but excision surgery—especially when paired with hormone therapy or other meds after—can help keep it under control long-term.
Ablation, on the other hand, works better for surface-level endo. It burns off the top layer of tissue but doesn’t reach the deeper spots, so it might not fully treat more severe cases.
Which procedure is best really depends on your unique endo—its type, location, and how it’s affecting you.
Recovery
Both procedures are usually done with laparoscopy (tiny incisions, faster healing), but excision can take a bit longer to bounce back from since it’s more thorough. Some people feel sore for a few days, others need a couple of weeks—everyone’s healing timeline is a little different. Be patient with yourself.
Fertility outcomes
If you’re thinking about future babies, excision is generally the MVP. Because it removes endo at the root and helps restore your anatomy, it can improve your chances of getting pregnant—especially if endo has been messing with your ovaries, tubes, or uterus. Ablation might help with pain, but it’s not as effective at boosting fertility and may increase the risk of pregnancy complications.
Why is it so Hard to get an Excision? — CPT Code 58662
CPT codes are like labels doctors use to tell insurance companies what procedure was done. Right now, both excision and ablation of endometriosis often get billed under the same code: CPT 58662, Laparoscopic Procedures on the Oviduct/Ovary.
The catch? This code doesn’t show the difference in time, complexity, or training required—so even though excision can be more advanced and take longer, both procedures are reimbursed the same by insurance. That can make things tricky for everyone: patients might not know which treatment they’re getting, and may be charged thousands of dollars, and providers aren’t always given the flexibility to code or be reimbursed accurately. This can make it hard to get an excision, despite it being a more effective option.
Questions to Ask Your Doctor
“Do you perform excision or ablation for endometriosis?”
“How many excision surgeries have you done?”
“Can you refer me to a specialist who treats endo with excision?”
“How likely is the endo to come back after this procedure?”
“What are the risks or complications I should know about?”
“Will my insurance cover excision surgery? What should I ask them?
Excision vs. Ablation: One Step Closer to Endometriosis Answers
We know—this is a lot to take in. But understanding the difference between excision and ablation is a powerful step toward taking back control of your endo journey. Whether you’re newly diagnosed or still searching for answers, you deserve real clarity and support.
Resources & Support
Lasa Health® is dedicated to supporting people suffering with endometriosis through personalized care, education, and a community.
Here's how we help:
Our mobile Lasa Health® app creates individualized plans to help manage endometriosis, offering insights into symptoms, treatment options, and at-home flare-up strategies.
Our 24/7 chatbot, provides instant answers to questions, suggests coping strategies, and assists with pain management techniques like pelvic floor and breathing exercises.
An AI-powered online Endometriosis Assessment Tool helps users understand their symptoms and receive guidance on next steps toward diagnosis.
Online support groups provide a platform for people to share patient stories and foster a sense shared experience among those affected by endometriosis.
References
Riley, K., Benton, A., Deimling, T., Kunselman, A., & Harkins, G. (2019). Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial.. Obstetrical & Gynecological Survey. https://doi.org/10.1097/OGX.0000000000000672.
Wright, J., Lotfallah, H., Jones, K., & Lovell, D. (2005). A randomized trial of excision versus ablation for mild endometriosis.. Fertility and sterility, 83 6, 1830-6 . https://doi.org/10.1016/J.FERTNSTERT.2004.11.066.
Duffy, J., Arambage, K., Corrêa, F., Olive, D., Farquhar, C., Garry, R., Barlow, D., & Jacobson, T. (2020). Laparoscopic surgery for endometriosis.. The Cochrane database of systematic reviews, 4, CD011031 . https://doi.org/10.1002/14651858.CD011031.pub2.
Garry, R. (2004). The effectiveness of laparoscopic excision of endometriosis. Current Opinion in Obstetrics and Gynecology, 16, 299-303. https://doi.org/10.1097/01.gco.0000136496.95075.79.
Pritts, E., & Miller, C. (2020). Endometrioma, Fertility, and the Recommended Surgical Treatment: An Evidence Based Approach. Journal of Minimally Invasive Gynecology, 27. https://doi.org/10.1016/j.jmig.2020.08.261.
Ibiebele, I., Nippita, T., Baber, R., & Torvaldsen, S. (2020). A study of pregnancy after endometrial ablation using linked population data. Acta Obstetricia et Gynecologica Scandinavica, 100, 286 - 293. https://doi.org/10.1111/aogs.14002.
