Why Your First Endometriosis Surgery Matters

By Dr. Victoria Vargas, Minimally Invasive Gynecologic Surgeon and Endometriosis Excision Specialist

By the time most endometriosis patients reach me, they have been living with symptoms for years. They have seen multiple physicians, tried different treatments, and are often carrying a quiet mix of pain, frustration, and doubt.

When we begin discussing surgery, I am very direct about one thing:

Your first endometriosis surgery matters. More than most patients are told.

What I See in Practice

A large portion of my patients have already had surgery elsewhere. Some come to me within months, still in pain. Others return years later, having never experienced meaningful relief.

In many of these cases, the issue is not that surgery was inappropriate. It is that the disease was not fully excised.

Endometriosis is not always obvious. This chronic, inflammatory disease can be subtle, deep, and involve multiple organs. Treating it effectively requires the ability to recognize and remove disease in all its forms, not just what is immediately visible.

Excision Requires Specialized Training

Endometriosis excision is a distinct surgical skill. It is not equivalent to ablation or surface-level removal.

If you are considering surgery, your surgeon should be:

• Fellowship-trained in minimally invasive gynecologic surgery
• Performing endometriosis excision weekly
• Experienced in managing complex and deep infiltrating disease

This level of experience directly impacts outcomes. When disease is left behind, symptoms often persist, and patients are placed in the difficult position of needing another operation.

The Problem With Unplanned Findings

One of the most common challenges arises when bowel endometriosis is discovered during surgery.

If a colorectal specialist is not already part of the operative plan, the surgeon must make a decision in real time:

• Proceed without the appropriate expertise
• Attempt to involve another surgeon who may not specialize in endometriosis
• Or leave disease behind

None of these are ideal. And for the patient, this often means incomplete treatment and the likelihood of repeat surgery.

Why We Plan Differently

At Washington Endometriosis and Complex Surgery, we approach this with intention.

For patients with suspected complex disease, we use dynamic ultrasound to map endometriosis before surgery. This allows us to understand where the disease is and how extensive it may be.

From there, we build a multidisciplinary surgical plan. If bowel involvement is suspected, a colorectal surgeon with expertise in endometriosis is present from the start.

This preparation is not incidental. It is central to achieving a complete excision in one operation whenever possible.

What Patients Deserve

Endometriosis takes, on average, close to 10 years to diagnose. By the time patients reach a surgical decision, they have already invested an extraordinary amount of time, energy, and trust.

They should not have to go through this process soon after their first surgery because the initial operation was not designed to address the full extent of their disease.

Our role is to provide:

• A thorough, thoughtful consultation
• Clear expectations about what we see and what it means
• A surgical plan grounded in experience and coordination
• Care that reflects how complex this disease truly is

The Bottom Line

The first surgery is often the best opportunity to change the course of endometriosis. When it is done with the right training, preparation, and team, patients have a far greater chance of meaningful, lasting relief.

If you are considering surgery, it is worth asking not just whether surgery is appropriate but also how it will be done, and by whom.

Because after everything it takes to get to this point, you deserve a plan built to fully address your disease the first time.

Dr. Victoria Vargas is a fellowship-trained minimally invasive gynecologic surgeon (MIGS) specializing in advanced endometriosis excision and complex, multidisciplinary care with over 10 years of experience. Trained at Harvard and the former Director of MIGS at Johns Hopkins (National Capital Region), she co-founded Washington Endometriosis and Complex Surgery to elevate the standard of care through precise, patient-centered treatment.