- Excision is the specialist standard for moderate-to-severe disease.
- Ablation is quicker but often leaves deeper disease behind.
- Ask your surgeon their annual volume and recurrence rate.
The core difference
Ablation burns endometriotic tissue on the surface with diathermy or laser. It is quicker and technically easier, but it treats only what is visible on the peritoneum — and endometriosis often extends deeper than the surface suggests.
Excision cuts out the endometriotic tissue with a small margin of healthy tissue, sending the specimen to histology for confirmation. It takes longer and demands more skill, but it removes the disease at its root.
What the evidence shows
For deep infiltrating and moderate-to-severe endometriosis, excision produces better pain relief, lower recurrence rates and higher fertility outcomes than ablation. For superficial disease alone, the evidence is closer to equivalent, but excision still provides histological confirmation.
What to ask your surgeon
'Do you excise or ablate?' is the single most important pre-surgery question. Also ask: how many endometriosis operations you do per year, whether you work in a multidisciplinary team, and what your personal recurrence rate is. A confident specialist will answer without hesitation.
Frequently asked questions
Is excision more painful to recover from?
Not usually — most women are back to light activity within a week either way.
Will excision leave scars?
Internally, all surgery leaves some scarring — but excision, done well, actually reduces the adhesion burden of untreated disease.
Does excision improve fertility?
For moderate-to-severe disease, yes: excision by a specialist improves natural conception rates in the 12 months after surgery.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation