Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:

There is some good news to discuss here, but the bad news is that your body NORMALLY heals using fibrosis and scarring as a natural healing mechanism to injury.  So, to some extent it is totally normal.  In some people, fibrosis or scarring is more pronounced; in others, there may be no or minimal thin adhesions, which are on the lower end of the fibrosis scale.  That can be related to surgical technique, tissue oxygenation, and cellular molecular pathway differences (based on genetics). This varies between people and can predispose towards more or less scarring.  Individual precision medicine measures will be possible based on molecular testing targets in the future, but we are not there yet.

The surgical technique itself does contribute to scar formation. More meticulous and less traumatic surgery, with less cautery, theoretically leads to less scar.  However, you had a master surgeon operate in your case and still ended up with fibrosis.  So, a better surgical technique does help but is not the complete answer.

In general, reliable prevention of adhesions and fibrosis has been elusive.  However, this is one reason to seek a master surgeon.  While bad surgical technique may not have been the cause in your case, it certainly is in other cases where burning, slashing, and tearing in the hands of novice or mediocre surgeons leads to more scar-producing trauma.

Minimally invasive surgery generally leads to fewer adhesions and fibrosis than open incisional surgery.  There is some research evidence that robotic surgery may be less traumatic than laparoscopic surgery, at least in some cases.  This may be due to the ability to more gently and meticulously handle tissue using precise robotic instrumentation. Prevention of inflammation through less trauma, less blood loss, and less cautery use helps as well.  These and other techniques that master surgeons use may reduce adhesions and fibrosis.

Numerous biological barriers and pharmaceutical approaches have been introduced over the years to reduce scarring, adhesions, and fibrosis.  In addition, integrative holistic approaches such as perioperative Bromelain hold some promise.  There is no clear winner to date, and various measures are used by different surgeons.  But there is some reason to believe that the more the surgeon does to reduce inflammation, improve local oxygenation of tissue and improve local lubrication using perioperative measures, the less fibrosis may result.  Suffice it to say that a meticulous master surgeon who studies the molecular causes of fibrosis and adhesions and applies reasonable counter-measures to reduce scarring may get you the best results.

For others reading this, beyond the excision part of endo surgery, this is also how an expert can improve your outcomes over average surgeons who do not specialize in endo.

*This is not medical advice and is aimed for informational use only. Please contact the doctor’s office or consult with your doctor for any medical questions.