Further to my private reply and for the benefit of others there are three types of endo that have been identified - peritoneal, ovarian (endometrioma) and deep nodular. Adenomyosis is considered to be at least a cousin of endo so may represent a fourth form. Peritoneal endo is what it says - endo on the peritoneum. The peritoneum is a thin membrane that lines the abdominal cavity and wraps round most of the organs within. It has the appearance of two layers but is one continuous sheet with a potential space between where peritoneal fluid is found. The pathogenesis of endo is unknown but the general belief among experts is that retrograde menstruation is likely to be the source of peritoneal endo - endometrium cells reaching the peritoneal fluid through refluxed menstrual blood entering the pelvic cavity through the Fallopian tubes and being deposited on the peritoneum to attach and grow.
For any tissue to grow or proliferate a blood supply is necessary and sometimes the peritoneum can have red 'angry' areas that may indicate the presence of early endo. These areas should be biopsied and sent to histopathology to identify if glands and stroma cells are present to confirm endometriosis. When peritoneal endo is excised then the effected part of the peritoneum is excised along with the endo. In a woman with extensive peritoneal endo (i.e. in a lot of places whether or not deeply infiltrating) it follows that many individual areas of peritoneum will be removed. TPPE takes this a step further and removes the whole pelvic peritoneum so that visible and any invisible (occult) microscopic endo is removed along with it. The question of whether microscopic endo exists is the subject of debate but there is supporting evidence and TPPE assumes that it does.
The peritoneum regrows and whether it can be affected with new endo depends on whether the retrograde menstruation theory is correct but a precaution after TPPE would be to minimise menstrual flow when possible with hormonal treatment if the woman can tolerate it. A point to be noted is that TPPE will have no effect on deep endo outside the peritoneum such as in the rectovaginal septum and so it would be important that this is excised too which any good surgeon would do.
The likely recovery time from TPPE will depend on a combination of the skill of the surgeon (it is a very intricate procedure), the depth of all endo involved and the healing process and pain tolerance of the individual woman. One woman with extensive mild peritoneal endo having TPPE cannot necessarily be compared with a woman with less extensive but deeper areas of endo requiring more invasive excision having TPPE. In my personal experience I had a 6.5 hour surgery involving extensive adhesiolysis, my bowel detached from my pelvic side wall, my bladder and both ureters shaved of endo and TPPE. I had very little post operative pain other than the soreness I would expect which was resolved with over the counter pain medications for up to a week or so. I remember having to carry a catheter bag around for a week being the biggest annoyance rather than pain as I was on my own with a child to look after. However, I did not have deep endo excised - that was dealt with four years earlier - so I suspect that post operative pain will not necessarily be related to the TPPE procedure but to the extent of deep excision carried out at the same time.