06/11/2026
This week in our endometriosis series: recurrence.
The most common question patients ask before surgery is whether endometriosis will come back. The honest answer is that recurrence is not a single number — and the number you may have been given deserves context.
Published recurrence averages combine many surgical settings, techniques, disease patterns, and surgeon case volumes. Ablation and excision are not the same procedure. Treating visible surface disease is not the same as fully dissecting deep infiltrating disease. When those surgeries are reported together, the resulting average describes the middle of a very wide distribution — not what any specific operation actually delivered.
Expert-center series using complete excision for complex disease consistently report different results. That gap is not coincidence. It reflects what was removed, how completely, and by whom.
Recurrence can also mean several different things. Visible disease left behind. Microscopic disease that progressed. New lesions in a patient with ongoing biological drivers. Or pain that returned for reasons unrelated to endometriosis — pelvic floor dysfunction, nerve sensitization, adenomyosis, or another overlapping pain generator. Separating those possibilities requires clinical evaluation, not a statistic.
For patients, the more useful questions are: What type of endometriosis do I have? Was deep disease suspected or found? Was excision performed, or was disease burned or superficially treated? Were the bowel, bladder, ureter, pelvic sidewall, and rectovaginal space evaluated? What else could be contributing to my symptoms? What is the long-term plan after surgery?
Complete excision, careful anatomy recognition, and appropriate long-term management can change the trajectory of care. No ethical surgeon should promise more than that — but the data from specialized centers suggests that the ceiling is meaningfully higher than the published average implies.
Part 4 next week.
Educational content only. Surgical planning should always be individualized.
Guo SW. Hum Reprod Update. 2009. / Roman H et al. Fertil Steril. 2023. / Meuleman C et al. Ann Surg. 2014.
