Frequently Asked
Questions

Recovery varies depending on the extent of disease and which organs were involved. Most patients return to light activity within one to two weeks. Full recovery from complex cases involving bowel or bladder takes longer.

We will walk you through specific recovery expectations before your surgery, not after. You will know what to expect at each stage before you go into the operating room.

Not necessarily. Surgery is appropriate for patients whose disease has been identified and whose symptoms are not adequately managed through other means. Some patients benefit from hormonal suppression, pelvic physical therapy, or other non-surgical approaches first, or in combination with surgery.

At WECS, Jenn Lanoff, our nurse practitioner and in-house pelvic pain specialist, manages non-surgical care for patients who are not surgical candidates or who are not ready for surgery. You do not have to choose between surgical and non-surgical care.

The most common reason patients have surgery and still have symptoms is incomplete excision. Not because the surgeon lacked skill. Because the disease extended beyond what one surgeon, in one specialty, is trained to treat.

Deep infiltrating endometriosis frequently involves the bowel, bladder, ureters, or diaphragm. When a surgeon encounters disease outside their training, they face a choice: leave it or improvise. Either way, the work is not finished.

Incomplete surgery means persistent symptoms. It means repeat operations, each one harder than the last because of adhesions and scarring from prior procedures. The goal at WECS is to remove the disease completely, in a single operation, so you do not have to come back for what was left behind.

Excision surgery for endometriosis requires skill that is not part of standard gynecologic training. Fellowship training in minimally invasive gynecologic surgery, or MIGS, provides the specific technical foundation for complex excision cases. Case volume matters because endometriosis presents differently in every patient, and surgical judgment develops through repetition.

Dr. Victoria Vargas and Dr. Melissa McHale are both fellowship-trained MIGS surgeons who perform excision surgery multiple times each week. This is not a procedure they perform occasionally.

Excision surgery removes endometriosis lesions at the root, cutting them out of the tissue they have invaded. Ablation burns the surface of lesions with heat or laser energy, leaving the deeper tissue in place.

The distinction matters. Ablation addresses what is visible on the surface. Excision addresses what is actually there. For deep infiltrating endometriosis, ablation is not adequate. The disease grows below the surface; burning the top of it does not remove it. Excision surgery is the surgical standard for complete treatment of endometriosis.

In the days immediately following surgery, your surgeon will check-in with you to confirm your recovery is on track. Most patients have two follow-up appointments after surgery.

The first is a two-week check-in by phone or virtual visit to review how you are feeling and go over your pathology results. The second is at eight to twelve weeks post-surgery, either virtual or in person depending on your procedure and preference.

Patients who had bowel surgery receive additional post-operative appointments with Dr. Obias, tailored to their specific case. At any point during recovery, our on-call line is available to you. If you need to be seen in the office or the emergency room, we make that happen.

Yes. Jenn Lanoff, our nurse practitioner, is one of the most sought-after pelvic pain specialists in the DC region. She manages non-surgical care including hormonal suppression, hormone replacement therapy, sexual dysfunction, and complex gynecologic conditions. She also coordinates referrals to nutritionists and other specialists.

Because Jenn works within the same practice as your surgeon, your care is coordinated rather than fragmented. If your needs change, we can adapt your plan without transferring you to a new practice.

Yes. We see adolescent patients and offer surgery for teen patients after thorough counseling. When we operate on teenage patients, we plan carefully to minimize disruption to school schedules and other commitments.

Yes. Your appointment is yours. Bring whoever you want there, for all of it or part of it. Many patients find it useful to have someone with them to help formulate questions in the moment, and to hear recovery information after surgery is discussed.

Your first appointment is one hour. That is not standard in most gynecology practices. We built it that way deliberately.

You will have time to tell us your full history: your symptoms, what you have already tried, what has and has not worked, and what matters most to you. Your surgeon will perform a dynamic transvaginal ultrasound during the appointment, walking you through everything she sees in real time. This imaging informs every subsequent decision: whether further testing is needed, whether you require consultations with other specialists, and what surgery would realistically involve.

You leave your first appointment with a clearer picture of what is happening in your body than you may have had after years of prior care.

Yes. WECS is built around a multi-specialty model because endometriosis does not confine itself to the reproductive organs. The rectum is the most common site of non-gynecologic spread, so Dr. Vincent Obias, our fellowship-trained colorectal surgeon, is present in the operating room for the majority of cases. When bowel disease is identified, it is addressed the same day by the surgeon best trained to treat it.

We also coordinate combined cases with specialists in:

• Urology
• Urogynecology
• Thoracic surgery
• Diaphragm reconstruction
• Abdominal wall reconstruction

The right specialist for your specific disease is in the room when your surgery happens. That is what prevents incomplete surgery and repeat operations.

No. WECS does not balance bill.

Initial consultation fees are structured as follows:

• If you do not have out-of-network benefits: the consultation fee is $400.
• If you have out-of-network benefits and have not met your deductible: we charge $400 and submit a bill to your insurance for the value of the visit beyond that amount.
• If you have out-of-network benefits and have met your deductible: we charge a $50 copay and submit a bill to your insurance.

Surgical fees for patients without out-of-network benefits are $10,000. For patients with out-of-network benefits, costs depend on whether your deductible has been met. We will walk through your specific situation at your consultation.

We do not balance bill. Hospital-based services, including anesthesia, pathology, and radiology, are billed separately by those providers and are in network with most major carriers.

Insurance companies do not recognize that endometriosis and other complex gynecologic conditions require subspecialty care that requires longer visits and complex procedures to fully treat. As a result, the payments we would receive if we were to “accept insurance” or be “in network with insurance” would not allow us to provide the high level of care we know our patients need. The hour-long appointments we provide would be valued at fifteen minutes, and a five hour surgery including removing endometriosis from blood vessels, bowels, ureters, the diaphragm, etc would all be valued as though we were spending 30 minutes cauterizing implants. This problem is reflected across the US; almost no academic centers or large in-network private practices have developed a multi-specialty endometriosis center because it is not financially viable to do so.

The reality is that treatment for endometriosis and other complex gynecologic conditions is so steeply undervalued in the American healthcare system that it is not possible to care for these issues at the expert level as an in-network practice and deliver the type of care that our patients truly deserve. Here at WECS we refuse to compromise on the level of care that we provide, and we will not undervalue the expertise of our multidisciplinary team. Therefore we fight alongside our patients as out-of-network providers to ensure that care for endometriosis and other complex gynecologic conditions is not only excellent but it is valued.

WECS providers are out of network with insurance, but what that means for you depends on your specific insurance plan.  

If you have out of network insurance benefits, we will submit bills directly to your insurance on your behalf. We will work with your insurance to ensure that they cover as much of your care with us as possible. The hospitals where we perform surgery and their anesthesiologists, pathologists, radiologists etc. are in network with most insurance carriers.