I'm not an expert on endometriosis; but I have learned that all doctors do not treat endometriosis in the same way. Some doctors treat endometriosis only with drugs! Other doctors believe that surgery is the only way to eradicate endometriosis. And doctors, who believe that surgery is the answer, vary as to what kind of surgical approach they take when they do surgery for endometriosis. Some surgeons use lasers; others use other kinds of surgical instruments.
If their patient has developed adhesions from past surgeries, it is very possible that endometriosis might be buried beneath the adhesions - out of the sight of the surgeon. Until a surgeon actually lyses these adhesions and excises (cuts out) the buried endometriosis, the disease of endometriosis will continue to cause problems.
In the past, I have mentioned the names of Dr. Harry Reich (NY and PA) and Dr. David Redwine (Bend, Oregon) because I know that they are very skilled and experienced endometriosis surgeons!! At the time of a surgical procedure for endometriosis, these surgeons actually send tissue samples to the pathology lab to make sure that they have removed every trace of endometriosis. Both of these surgeons have the skill and experience of recognizing the many different kinds of endometriosis. Endometriosis can also be microscopic; this is when these two surgeons rely upon the pathologist to help them determine if they've removed every trace of endometriosis.
Unless the surgeon possesses the skill and experience similar to that of Dr. Reich and Dr. Redwine, for example, then it is very possible that the endometriosis will return. If only one implant is missed, this implant will continue to respond to the menstrual cycle by bleeding internally and thus cause more implants and more scarring.
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Recently, someone shared her concerns about endo with me. She said: When Dr. Reich says that my endo will not come back, how can he know this for sure? (Dr. Harry Reich performed her surgery at Scranton, PA.) What happens during my cycle now, that these cells will no longer be deposited outside the uterus?" She continued by saying:
"I think this is a very interesting question. I had a doctor in the midwest who was so sure of his technique for removing endo that he was the source of my most insulting response from a Dr. When I still had pain after the surgery (which, of course, I now know to be from adhesions), he kept repeating over and over, "I have removed the disease; there is no cause for pain."
"When I finally had a hysterectomy, there was a great deal of endo that had not been removed. I also have a good friend who, because of endo, had a total hysterectomy about 14 years ago. Recently, she had some bleeding and learned that it was endo that was causing it. Apparently, there really are no guarantees concerning the total removal of endo."
To answer her questions, I encourage endometriosis sufferers to learn as much as they can about endometriosis. I will post a list of the best sources on the Internet for information about Endometriosis.