Gold Standard

On many occasions I have heard excision surgery referred to as the 'Gold Standard' of endometriosis treatment.

I'm in North Wales and there isn't a hospital here that does excision surgery. I'm going to ask for a referral to a BSGE accredited hospital in England. This will mean securing cross - border funding which is notoriously difficult.

I'd like to go to my next appointment with my consultant armed with the facts regarding excision and the NHS view on it. Can anyone point me in the direction of an article/journal about excision as the 'Gold Standard' of treatment.


5 Replies

  • Hi

    Excision is considered the gold standard because when carried out effectively it removes all endo so it cannot regrow. Ablation methods burn/vaporise the endo to a certain depth which in the case of minimal disease may destroy it equally well. But the problem is that on visualising endo at a laparoscopy it cannot be seen just how deep any particular lesion goes and invariably ablation won't fully destroy it, especially when carried out by general obstetricians. Whether or not new endo can grow in new places after a thorough excision is a subject of debate that cannot yet be answered because the origin of endometriosis is still not known. It is a fact that even after excision endo does sometimes recur but the period free of symptoms is usually considerably longer.

    With regard to the NHS view in England this is contained in their standard contract based on guidelines by the European Society of Human Reproduction and Embryology. Since the ESHRE guidelines refer to Europe those would apply to Wales too but I don't know if they have a similar contract or what protocol would apply if you got referred to England. The fact is that care under the NHS is constrained by finances and excision is expensive. So surgery in an NHS centre may vary from a combination of ablation techniques for mild to moderate disease and excision for severe stage 3/4 disease as recommended by these guidelines to full excision depending on the methods and expertise of the individual surgical team. Either way you should be assured that in an accredited centre all significant disease would or should be excised for the best outcome. You can access the documents at the links below:

  • Hi I am having surgery with Mr Trehan on 2 July to have endo completely removed without removing any organs! Look on his site he has pioneer this and it will explain everything. Good luck

  • Hi - we are not allowed to name specialists so your post might be removed but this centre is private only. All endo would be thoroughly excised in that case including the entire pelvic peritoneum if considered appropriate. But this will be costing anything from 15 to 20K for the severest cases. Anyone having surgery on the NHS is bound by their protocol and whilst some do carry out PTTE not all do as it is not 'approved' NHS procedure and very few have the required expertise.

  • Sorry only trying to help after the misery I have faced from NHS failures. I appreciate that this does cost and I just wanted endo suffers to know because it took me such a long time to find. When I read people comments a lot of us, like I are employed or have a career ahead of us and I wasn't prepare to lose my job or life to this illness therefore I felt this was my priority. Sorry if I've offended anyone.

  • I'm in a similar position although I'm TTC which at the moment is my priority. I have only had a diagnostic laparoscopy to date but i'm not prepared to go through diathermy time after time with the long term impact it has (adhesions, scar tissue etc).

    I may end up going privately too for surgery. This would mostly wipe out our savings and leave us with very little for IVF should we need it later on.

    It's a dilemma!

    Are you in Wales too Clairecarebear?


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