Surgery Success Rates

So how do we measure our rate of success? When patients come to us for treatment, we begin by carefully assessing their symptoms. This process of assessment does not end at surgery but is ongoing in the form of patient follow-up by phone and questionnaire. This allows us to keep track of how our patients are doing long-term. We have been carefully following-up our patients for over a decade, providing an accurate picture of our post-surgery success rates. There are only a few centers worldwide that offer a similar follow-up process and typically the results are only revealed in medical circles and not made transparent to patients. Due to lack of follow-up, most surgeons simply have no idea how well their patients are doing beyond the initial post-operative check-up.

Why is follow-up important? Firstly, it means the door is always open to past patients should they encounter problems in the future. We do not turn our backs on our patients. Secondly, we are able to refine the treatments we offer and develop an understanding of the optimal “recipe for success” in treating a range of patients with pelvic pain. It enables us to learn more about our patients and about endometriosis. Simply, the better our understanding the better we can help. Thirdly, and lastly, our follow-up process allows us to provide prospective patients with objective and realistic success rates in terms of symptom relief and need for reoperation. We appreciate that when making decisions about health care it is of the utmost importance that the patient is as fully informed as possible about what to expect not only during treatment but also in the long run. This fosters trust and confidence. Nothing could be more relevant than in the case of endometriosis treatment, where patients often feel like they have been let down or misinformed by their healthcare providers.

In the vast majority of cases, a single laparoscopic surgery with Dr. Cook to meticulously remove all areas of endometriosis will bring about long-term relief of symptoms. 84% of Dr. Cook’s patients did not require further surgery despite ongoing follow-up. When interpreting reoperation rates it is important to recognize that reoperation may not only be indicated to treat recurrent or persistent endometriosis but may also be as a result of other gynecological disorders. For example, a condition that may co-exist with endometriosis is adenomyosis (where endometriotic tissue involves the muscular walls of the uterus). So even if removal of endometriosis has been complete, some patients may later return for surgery to treat other associated pelvic disorders.

With over a decade of follow-up of hundreds of patients we have found a recurrence rate of under 7% following excision surgery with Dr. Cook. Interpreting recurrence rates can be difficult. Given only a relatively small percentage of our patients ever undergo reoperation and given recurrence can only be established via surgery, it is the assumption that patients who are pain-free have no recurrence. Perhaps more accurately we should say that of all our patients who undergo surgery for endometriosis, less than 7% are found to have endometriosis at reoperation and therefore recurrent pain following initial surgery is unlikely to be due to recurrent endometriosis. Another important question is whether recurrence equates to mere disease persistence or true cases of disease recurrence. Was disease missed or has new disease formed since the earlier surgery? Given the low rate of endometriosis detected at reoperation after careful removal of all disease, Dr. Cook’s results suggest that true recurrence is in fact a rare event and in most cases all endometriosis can be successfully treated without recurrence. This may come as a surprise to many readers since most doctors insist that surgery is at best a Band-Aid and that the disease will inevitably return in time (why do surgical results differ between specialists and non-specialists?) As you can see, our success rates, however, beg to differ.

We mention previously that of the small number of centers worldwide that have collected long-term data on their patients, success rates are typically only reported within medical circles. An obvious question you may be pondering is how do Dr. Cook’s surgical success rates compare with those of other world-renowned endometriosis surgeons, published in the scientific literature. The answer is that our results concerning reoperation and disease recurrence rival those published by predecessors in the field [1,2,3]. Dr. Cook takes pride in providing his patients with the best surgical care available.