Still in Pain After Endometriosis Surgery?
Pain after surgery has more than one cause, and another operation helps only some of them. A second opinion starts with your records, to find out which root cause(s) may be yours.
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute
The short answer
Another surgery is worth considering when:
- disease was left behind, or burned rather than removed (ablation)
- the pain came back after months or years of relief, the way it was before
- endometriosis on the bowel, bladder, ureters or diaphragm wasn't treated
- an organ is at risk: a narrowing ureter or bowel, or a growing cyst
It's less likely to help when the pain comes from a sensitized nervous system, the pelvic floor or another condition. Those need a different or additional plan, and a good second opinion tells you which.
Side by side
Why the pain can continue
Most people have more than one cause, and each needs its own answer. Disease left behind, or disease that came back, can often be removed. Scar tissue sometimes can. Adenomyosis, the pelvic floor and a sensitized nervous system need other care, not another excision.
That's why the cause comes before the surgery. Our series Why do I still hurt? goes deeper into each one.
| Cause | Typical clues | Will another surgery help? |
|---|---|---|
Disease left behind | Pain never really improved, or came back within months. The operative report mentions burning (ablation, fulguration) or disease that wasn't removed. | Often, when it's removed completely this time. |
Disease that came back | Months or years of relief, then the old pain returns. | Often, once a careful work-up confirms it. |
Scar tissue (adhesions) | Pulling or sharp pain with certain movements or positions. | Sometimes; scar tissue can also form again. |
Adenomyosis | Heavy, painful periods and a tender, enlarged uterus. | Not excision: adenomyosis has its own treatments. |
Pelvic floor or a sensitized nervous system | Pain that's spread out, burns, or never lets up; pain with sitting or sex. | No. Pelvic floor therapy and pain care help instead. |
How it works
What a second opinion looks at
It starts with your records, not an appointment. We read them first, then tell you plainly whether we think we can help.
Operative and pathology reports show what was done the first time, and what wasn't. Photos, video and imaging fill in the rest, and your timeline shows how the pain has behaved since. The more of it you can gather, the more the review can tell you.
Gather these first
- Operative reports from every surgery
- Photos or video from surgery, if you have them
- Pathology reports: what was removed, and what it was
- Imaging reports, and the images if you can get them
- A timeline: when the pain improved, when it came back, and what you've tried
Records review
Dr. Vasilev's team reads your operative and pathology reports and imaging before you meet, so the consultation starts from what was actually done.
Video consultation
What was found, what was removed, what wasn't, and how your pain has behaved since.
Testing
Imaging read by an endometriosis expert, and tests for the conditions that mimic endometriosis or add to it.
Your plan
Sometimes it's another surgery; sometimes it's pelvic floor therapy, pain care or the kindest and gentlest hormonal support and integrative options. If it's surgery, insurance and a fixed price are settled before anything is booked.
Before you decide
Questions to ask before another surgery
Ask them of any surgeon, including us. A good one will be glad you did.
A second surgery should have a target, so the first three questions are about what was left behind, how it will be removed, and who treats it on the bowel, bladder, ureter or diaphragm. The last three are about everything around the operation: what else could be keeping the pain going, what changes the second time, and the plan afterwards.
What do you think was left behind, and where?
A second surgery should have a target, not just a hope.
Listen forA specific answer, drawn from your records and imaging.
Will you remove it, or burn it?
Burning (ablation) treats the surface and is a common reason pain returns.
Listen forExcision, wherever it's found.
If it's on my bowel, bladder, ureter or diaphragm, who treats it?
Disease in these places is often what an earlier surgery couldn't reach.
Listen for"I do, in the same operation," with any other specialists planned in advance.
What if it isn't endometriosis?
Adenomyosis, the pelvic floor and nerve pain can all keep pain going.
Listen forA plan for those too, not just another operation.
What's different about operating a second time?
Scar tissue moves organs out of place, so a repeat surgery takes more skill, not less.
Listen forExperience with repeat surgery, and how organs are kept safe.
What happens afterwards to keep it from coming back?
Surgery is a turning point, not the finish line.
Listen forA follow-up plan: pelvic floor therapy, hormones when they fit, and check-ins.
Your surgeon
How Dr. Vasilev approaches repeat surgery
A repeat surgery means scar tissue, organs out of place, and disease an earlier operation couldn't reach. Dr. Vasilev's training as a gynecologic oncologist is for exactly that kind of distorted anatomy.
Sometimes the answer isn't another operation. When your records point to the pelvic floor, adenomyosis or nerve pain, he'll tell you, and the plan starts there instead.
“The most important part of a second surgery happens before it starts: planning around why the previous one may have failed.”
His answers to the questions above
1. What do you think was left behind, and where?
Every earlier operative and pathology report, read before your consultation.
2. Will you remove it, or burn it?
Excision, wherever the disease is.
3. If it's on my bowel, bladder, ureter or diaphragm, who treats it?
He does, including the diaphragm.
4. What if it isn't endometriosis?
He'll tell you, and the plan starts there instead.
5. What's different about operating a second time?
Trained as a gynecologic oncologist, for exactly this kind of distorted anatomy.
Ask him question 6 at your consultation.
Schedule ConsultationPatients often ask
When should I get a second opinion for endometriosis?
A second opinion is worth seeking when symptoms persist despite treatment, your pain is minimized, or you face a major treatment decision without a clear plan. Normal imaging, changing pelvic pain, or incomplete relief after surgery are also reasons to seek a review.
When is repeat excision surgery recommended?
Repeat excision is typically considered when symptoms return or progress and there’s strong reason to believe endometriosis or adhesions are driving them, or when organ function is at risk. Pain after surgery doesn’t always mean disease has returned, so re-evaluation may be needed.
Did ablation cause my endometriosis pain to return after surgery?
Yes, ablation can be one reason pain returns after endometriosis surgery because it may leave deeper disease or inflammation behind. Returning pain can also come from scar tissue, adenomyosis, pelvic floor dysfunction, or disease in hard-to-reach areas.
Can endometriosis come back after excision surgery?
Yes, endometriosis can come back after excision surgery, even when it is performed well, though more often over years than weeks. Disease left behind is the biggest driver. Signs include familiar pelvic, period, bowel, or bladder pain returning after relief, but returning pain doesn’t always mean returning disease.
You’re on step 1 of 3
Next: Who should operate?What to look for in any surgeon, and Dr. Vasilev’s results.