Laparoscopic Excision (LAPEX) is the surgical procedure of choice for treating endometriosis. It’s a multidisciplinary approach for endometriosis surgery where excision specialist also involves colorectal surgeon, uro-surgeon and other specialities for optimum excision of disease. If the disease is not excised well chances of recurrence will be very high and also pain relief will not be complete.
Excision Versus Ablation
Excision is removal of endometriotic implants by cutting them away from surrounding tissues and organs. The endometriotic tissue is ideally scooped down to the roots and anatomy is restored for optimum functioning. The excised tissue is sent for pathologic confirmation as well. When this surgery is done by excision expert, it has a very low rate of recurrence, provides good symptomatic relief and enhances fertility and leaves a positive impact on patient’s life.
Whereas ablation also known as fulguration/ vaporiization/ coagulation is a method whereby the endometrial tissues are burned using heat, laser or cautery methods. This method has not proven successful for endo treatment as endometriosis is like an iceberg, what we see is just the tip and the remaining is deep inside which needs to be excised. Fulguration burns only the tip and women will be symptomatic even after this treatment. If your doctor advices fulguration, you need to take a second opinion and go for excision specialist. This method causes more tissue damage and scarring and also we don’t get tissue for pathologic confirmation. There is also a possibility of damaging the underlying tissue such as bowel, bladder, ureter and other vital organs. This type of treatment leads to recurrence and multiple surgeries. Ablation or fulguration acts on the surface of the lesion but leaves the active disease below it and it is particularly true for deeply invasive nodules and deep infiltrating endometriosis (DIE). Excision is always preferable as we don’t know the extent and depth of disease simple by looking at it. Various studies and clinical trials have proved that excision is more effective and the best way to treat endometriosis than ablation.
Who performs the surgery?
Excision is a highly complex, modern, and advanced surgical technique and requires extensive training. Accuracy in diagnosis and treatment options are dependent on the surgeon to recognize endometriosis disease in all its different manifestations. A trained, expert Surgeon can treat endometriosis to its perfection.
Globally more than 200 million women are suffering with endometriosis but only a handful of surgeons are excision experts.